ORIGINAL ARTICLE Pain is not Systematically Registered in Dutch Medical Oncology Outpatients Nienke D. te Boveldt, MSc*; Myrra J.F.J. Vernooij-Dassen, PhD †,‡ ; Anne Jansen, BSc*; Kris C.P. Vissers, MD, PhD, FIPP*; Yvonne Engels, PhD* *Anaesthesiology, Pain and Palliative Medicine Department, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen; IQ Healthcare Department, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen; Kalorama Foundation, Beek-Ubbergen, The Netherlands & Abstract Background: Systematic pain registration and assessment with a visual analog scale (VAS) or numeric rating scale (NRS) at each visit are key recommendations in one of the most recent guidelines on cancer pain management. It is unclear whether this recommendation is applied. Objectives: The aim was to explore registration of pain in medical records of patients visiting the medical oncology outpatient clinic. Methods: In a multicenter study in six Dutch hospitals, data were extracted from medical records of 380 outpatients with cancer. Data of the first three visits at the outpatient clinic were studied. Descriptive statistics were conducted. Results: In 23% of all 987 visits at the outpatient clinic, pain or absence of pain was registered, and in an additional 15%, a nonspecific symptom description was given. Regarding all other visits, (62%) pain or absence of pain was not docu- mented at all. Pain measurement using a VAS or NRS was documented in only one visit. Pain was more often registered in medical records of patients with metastasis, as well as in those of patients with urogenital tumors. Conclusion: Pain in medical oncology outpatients is not systematically registered in their medical records. With one exception, pain was not registered with a VAS or NRS. Yet, registration and assessment of pain to monitor pain are essential to evaluate and adapt pain treatment over time. Pain registration has not improved since 2001 and therefore implementing the recommendations regarding systematic monitoring of pain is needed. & Key Words: pain registration, cancer, pain assessment, pain management INTRODUCTION Pain is one of the most prevalent symptoms of patients with cancer, 1 which hampers daily activities 2 and quality of life. 35 Cancer pain is also associated with anxiety, depression, and sleep disturbances. 35 Preva- lence of pain ranged from 27% 6 to 60% 7 in patients with cancer visiting outpatient clinics. Inadequate pain treatment ranged from 31% 8 to 65% 6 in patients with cancer. Although adequate pain relief in 71% 9 to 86% 10 of cancer pain is considered feasible, pain is still undertreated. Despite the availability of many evi- dence-based therapies for cancer pain and clinical practice guidelines (CPGs), 1113 pain in patients with cancer is still a major problem. Systematic pain assessment and documentation using a validated pain assessment tool, such as a visual analog scale (VAS) or numeric rating scale (NRS), at each visit Address correspondence and reprint requests to: Nienke te Boveldt, MSc, Radboud University, Nijmegen Medical Centre (RUNMC), Huispost 717, Geert Grooteplein 10, 6500 HB, Nijmegen, The Netherlands. E-mail: nienke.faber-teboveldt@radboudumc.nl. Submitted: August 02, 2013; Revision accepted: December 03, 2013 DOI. 10.1111/papr.12180 © 2014 World Institute of Pain, 1530-7085/13/$15.00 Pain Practice, Volume , Issue , 2014 