Controlling Cancer Pain Requires Detailed Planning and Persistent Effort by Committed Interdisciplinary Team

BALTIMORE—Between 65% and 85% of advanced cancer patients suffer pain, but between 85% and 95% of those patients, if properly treated, can experience relief. Providing effective pain management is a multidisciplinary effort requiring detailed planning and persistent implementation by a team committed to using a variety of resources and techniques. These concepts and how they are integrated into the Johns Hopkins approach to pain management were described by Suzanne A. Nesbit, PharmD, BCPS, clinical specialist in pain management in the Department of Pharmacy at Johns Hopkins Hospital in Baltimore and Kathy Smolinski, LCSW-C, senior clinical social worker in the Cancer Pain Service of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Controlling Pain

Central to the Hopkins approach is the belief that "communication is the key" to properly assessing and controlling pain, Ms. Smolinski said at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting. As a first step toward pain control, each cancer patient seen at Hopkins completes a common problem checklist. The answers help members of the Cancer Pain Service combine assessing a patient’s level of pain with educating him or her about pain control, Dr. Nesbit said.

Pain Rated Daily

The program includes a pain rating done for each patient daily, she continued. Anyone reporting a pain level of four or higher is evaluated by the pain service, which is committed to "return [to the patient’s case] relentlessly until the pain is managed," Dr. Nesbit said. Special rounds and weekly case conferences also concentrate on controlling each patient’s pain. To help streamline the pain control team’s work, the special data base being developed can be accessed by a palm-held computer.

Patients overwhelmingly report that their nurses are the best source for education about pain management, Ms. Smolinski added. Because patients often feel unsure what or how to ask, nurses at Hopkins use handouts, including a question and answer sheet intended both to answer patients’ unspoken questions and to encourage discussion. At discharge, each patient also receives specific pain management instructions, she noted.