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.
3–5
Cancer pain is also associated with
anxiety, depression, and sleep disturbances.
3–5
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),
11–13
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 –