This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldberg, G. R. Articles by Morrison, R. S. Search for Related Content PubMed PubMed Citation Articles by Goldberg, G. R. Articles by Morrison, R. S.

Pain Management in Hospitalized Cancer Patients: A Systematic Review

Gabrielle R. Goldberg, R. Sean Morrison

From the Division of Hematology and Medical Oncology, Samuel Bronfman Department of Medicine; Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York; and The Bronx/NY Harbor Geriatric Research, Education, and Clinical Center, Bronx, NY

Address reprint requests to R. Sean Morrison, MD, Brookdale Department of Geriatrics, Box 1070, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029; e-mail: sean.morrison{at}mssm.edu

Purpose: To assist cancer centers in improving pain management, we conducted a systematic review of institutional interventions designed to improve the assessment and treatment of pain in hospitalized cancer patients.

Methods: We performed a MEDLINE search for all English-language articles published from January 1966 through February 2006 using the medical subject headings terms of pain or pain measurement and outcome assessment (health care) or quality assurance (health care). Selected bibliographies were also searched. Studies were reviewed if they included clinical interventions directed at improving the treatment of cancer pain across an institution or nursing unit. Meta-analyses and randomized controlled trials or other controlled studies were included where possible. If no such trials were identified, then the best evidence available from studies with other designs was included.

Results: Five interventions were identified. These interventions included professional and patient education, instituting regular pain assessment (pain as a vital sign), audit of pain results and feedback to clinical staff, computerized decisional support systems, and specialist-level pain consultation services. Most studies were small in size and used quasiexperimental pre-post test designs. Successes were reported in increasing patient satisfaction, increasing documentation of pain intensity, and improving nurses’ knowledge and attitudes. No study reported successful interventions that consistently improved patients’ pain severity.

Conclusion: Although professional knowledge and attitudes about pain and nursing pain assessment rates have been shown to be improvable, no systematic, hospital-wide intervention has yet to be associated with improvement in pain severity. Future research on the development of new interventions, perhaps targeted specifically at physicians, is urgently needed.

Supported by Mid-Career Investigator Award in Patient Oriented Research No. K24 AG022345 from the National Institute on Aging (R.S.M.); also supported in part by the National Palliative Care Research Center, New York, NY.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

This article has been cited by other articles:

				M. Maltoni Opioids, pain, and fear Ann. Onc., January 1, 2008; 19(1): 5 - 7. [Full Text] [PDF]

				L. M. Minasian, A. M. O'Mara, B. B. Reeve, A. M. Denicoff, J. Kelaghan, J. H. Rowland, and E. L. Trimble Health-Related Quality of Life and Symptom Management Research Sponsored by the National Cancer Institute J. Clin. Oncol., November 10, 2007; 25(32): 5128 - 5132. [Abstract] [Full Text] [PDF]