Background & Aims

Pain is a feared symptom of cancer and is likely to diminish the general well-being and quality of life of patients. The role of appropriate pain assessment cannot be underestimated in the optimal management of cancer pain. Cancer pain is a subjective experience with associated physical, psycho-social, and spiritual suffering where self-reported pain is considered the gold standard. However, during follow-up visits, self-reported pain in the preceding weeks may be inaccurate due to recall bias [1]. Inaccuracies in reported pain lead to suboptimal pain management with poor outcomes. Standardized pain tools are therefore recommended to reduce inaccuracies in assessed pain and to guide treatment and improve outcomes [2]. This study evaluates the efficacy of a holistically-based pain diary as a follow-up tool for pain assessment for Sri Lankan cancer patients.

Methods

A nonequivalent control group pre-test/post-test quasi-experimental study at Medical Oncology Clinics at the National Cancer Institute Sri Lanka. Outpatients aged 18–65, who experienced cancer-related pain for ?3 months were included; non-cancer-related pain and frail/mentally unfit, disoriented patients were excluded. A consecutive sampling approach yielded (n=67) per group.
Tools: validated pain diary [3], Sinhala versions of SF BPI [4], SF MPQ-2 [5], and EORTC QLQ C30 [6]. Pre-tested intervention evaluation questionnaires for patients and professionals collected data.
Baseline and 4th /8th-week data on pain severity, interference, qualities, and quality of life were collected from both groups. The intervention group used a pain diary, with recordings done daily. Experience of pain was evaluated using the diary at the 4th and 8th weeks by the physician at the clinic. The control group was assessed using other tools.

Results

The intervention and control groups had similar socio-demographic, illness, and treatment characteristics except job status (p= 0.019). Pain severities, interferences, characteristics, and quality of life did not differ between intervention and control groups at baseline or 4 weeks. Mean ‘pain now’ scores decreased significantly from baseline to 8th week in intervention (p=0.005) and control groups (p=0.022). Interference to ‘walking ability’ (p=0.044) and ‘Normal work’ decreased (p=0.008) in the intervention group, while interference to ‘Relationships with others’ (p<0.000) and ‘Enjoyment of life’ increased (p=0.041). About 75% of participants found the pain diary helpful. Over 80% of cancer patients recommend this pain diary. All healthcare workers appreciate pain diaries for follow-up holistic pain assessment.

Conclusions

There was no significant difference in pain severities between groups or pre-post intervention. The study participants and the health care providers were satisfied with the content covered and the quality of the holistic aspects-based follow-up pain assessment diary recommended for future use.

References

1.Stone, A. A., Shiffman, S., Schwartz, J. E., Broderick, J. E., & Hufford, M. R. (2003). Patient compliance with paper and electronic diaries. Controlled clinical trials, 24(2), 182–199. https://doi.org/10.1016/s0197-2456(02)00320-3
2.Hooten, M., Thorson, D., Bianco, J., Bonte, B., Clavel Jr, A., Hora, J., Johnson, C., Kirksson, E., Noonan, M.P., Reznikoff, C., (2017). Pain: assessment, non-opioid treatment approaches and opioid management. Guideline Summary. Institute for Clinical Systems Improvement website. https://www. icsi. org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/pain/. Revised August.
3.Edirisinghe NP, Makuloluwa PTR, Amarasekara AATD, Perera GLSN, Goonewardena CSE. Development and Validation of a Holistically Based Follow-Up Pain Assessment Diary Leading to Holistic Nursing for Patients with Cancer Pain in Sri Lanka. J Holist Nurs. 2023 Aug 21:8980101231193942. doi: 10.1177/08980101231193942. Epub ahead of print. PMID: 37605465.
4.Edirisinghe, N. P., Makuloluwa, T. R., Amarasekara, T. D., & Goonewardena, C. S. E. “Evaluating Psychometric Properties of the Short Form Brief Pain Inventory Sinhala Version (SF BPI-Sin) among Sinhala Speaking Patients with Cancer Pain in Sri Lanka.” BMC Psychology 9, no. 1 (December 2021): 34. https://doi.org/10.1186/s40359-021-00538-1
5.Edirisinghe, N. P., Makuloluwa, T. R., Amarasekara, T. D., & Goonewardena, C. S. E. (2019). Psychometric Properties of Sinhala Version of Short-Form McGill Pain Questionnaire-2 (SF MPQ-2-Sin) among Patients with Cancer Pain in Sri Lanka. Pain Research and Management, 2019, 1–6. https://doi.org/10.1155/2019/5050979
6.Jayasekara, H., Rajapaksa, L.C., & Aaronson, N.K. (2008). Quality of life in cancer patients in South Asia: psychometric properties of the Sinhala version of the EORTC QLQ-C30 in cancer patients with heterogeneous diagnoses. Quality of Life Research, 17, 783-791.

Presenting Author

Nirosha Edirisinghe

Poster Authors

Nirosha Edirisinghe

PhD

University of Colombo, Sri lanka

Lead Author

PTR Makuloluwa

General Sir John Kotelawala Defence University, Sri Lanka

Lead Author

AATD Amarasekara

University of Sri Jayewardenepura, Sri Lanka

Lead Author

SN Perera

National Cancer Control Programme, Ministry of Health, Sri Lanka

Lead Author

CSE Goonewardena

University of Sri Jayewardenepura, Sri Lanka

Lead Author

Topics

  • Assessment and Diagnosis