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No Need To Suffer In Silence

No Need To Suffer In Silence

Lessons from a pilot project on improving pain management for cancer patients will become part of an Australia-wide awareness campaign for hospitals and patients during 2005.

"The target is the current under-treatment of pain for patients with cancer, a world wide problem, but which is largely avoidable," says Dr. Ruth Cornish, manager of the project for the National Institute of Clinical Studies (NICS).

"The message is that cancer patients need not suffer in silence - there are treatments for their pain.

"The project sought to improve the day-to-day management of cancer patients' pain, initially by providing hospital teams with tools and strategies to help them overcome the organisational, clinical and patient barriers to effective pain management," she said

Dr. Cornish will outline the NICS project this weekend (Saturday 7 May) at the Annual Scientific Meeting (ASM) of the Australian and New Zealand College of Anaesthetists (ANZCA) in Auckland (NZ). The ASM will be attended by 1,000 anaesthetists, intensivists and pain medicine professionals from around the world. (Eds.: ASM runs from 7 May to 11 May). The theme of the meeting is "Improving Outcomes".

"There is a significant gap between best available evidence and current clinical practice in the assessment and management of pain," Dr. Cornish explained.

"Cancer pain can be well controlled in 80 to 90 per cent of patients when treatment is tailored to the individual.

"Evidence-based guidelines are available for managing cancer pain, but traditional attitudes, practices and beliefs hinder effective pain relief and many patients suffer unnecessarily.

"Attitudes that pain is inevitable and is merely a symptom that is not harmful in itself are major barriers to effective pain management, while other misconceptions persist about tolerance, addiction and side effects related to opioid analgesics used to treat severe pain.

"Patients sometimes remain silent and stoic, rather than say they are in pain, while doctors and nurses sometimes underestimate the severity of patients' pain," Dr. Cornish said.

Eight hospitals that took part in the pilot project (during 2004) formed teams involving doctors, nurses, pharmacists, quality managers and hospital executives.

All sites began on a small scale, testing the use of existing evidence on improving routine pain management practices, with experiences being shared among the hospitals.

Interventions included raising awareness, engaging ward-based nurses to champion the project among staff and patients, placing posters in wards to overcome patient reluctance to ask for assistance and, at one hospital, "Pain busters" badges were worn by staff to get the message across.

Conversion tables equating dosage rates for different drugs were made readily available to staff and were particularly useful when pain medications were being changed.

"Documentation of patients' pain scores improved from generally less than 20 per cent at baseline to 60 to 100 per cent over the pilot year," Dr. Cornish said.

"This national pilot program uncovered many lessons for hospitals and other organisations interested in system-wide improvements to routine pain management," Dr. Cornish said.


The National Institute of Clinical Studies, established in 2000 by the Australian Government, is Australia's national agency for improving health care by helping close important gaps between best available evidence and current clinical practice.

The pilot cancer pain management program is being evaluated, with key findings to be made available to all interested organisations.

The participating hospitals were:
Royal Perth W.A.
Sir Charles Gairdner. W.A.
Flinders Medical Centre S.A.
Royal Adelaide S.A.
Peter MacCallum Cancer Centre VIC.
Newcastle Mater Misericordiae, N.S.W.
Westmead, N.S.W.
Royal Brisbane & Women's QLD.

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