Tse, M.M., Wong, A.C., Ng, H.N., Lee, H.Y., Chong, M.H., & Leung, W.Y. (2012). The effect of a pain management program on patients with cancer pain. Cancer Nursing, 35(6), 438–446.

To determine if a specified pain management program for cancer patients is associated with pain reduction, an increase in pain medication, and a reduction in barriers to pain management

Participants were assigned to an experimental group or a control group. Each group received routine pain management education, including a one-page pamphlet about pain and the use of pharmacotherapeutics and nonpharmacotherapeutic pain relief methods.  Follow-up sessions of approximately 15 minutes each occurred on days 3 and 5. Follow-up sessions included pain assessment and reinforcement of information from the booklet. The experimental pain management program included a 30-minute individual education session and follow-up sessions on days 3 and 5. On follow-up days pain was assessed and education and management methods reinforced.

• The sample was composed of 38 patients.
• In the experimental group, mean patient age was 61.96 years. In the control group, mean patient age was 63.94 years.
• Of all patients, 60% (24 patients) were male; 13 men were in the experimental group and 11 men were in the control group. Of all patients, 40% (14 patients) were female; 7 women were in each group.
• The sample included various cancers, including breast, bone, lung, gastrointestinal, genitourinary, and skin cancers, with and without metastases.
• At baseline, pain intensity in the experimental group was 4.7; in the control, 4.2. All participants took analgesics regularly to relieve pain, and 60% used nonpharmacologic methods to control pain. Length of stay was seven days.

• Single site
• Inpatient
• Palliative care and hospice ward, Hong Kong
   

• Phase of care: end-of-life care
• Clinical applications: end-of-life care and palliative care

Prospective randomized controlled trial with pre/post-test

• Numeric Rating Scale, a Likert-type self-report
• Barriers Questionnaire-Taiwan (BQT), which offered an internal consistency of 0.89 and a test-retest reliability of 0.90
• Record Sheet for PRN Analgesic (a component of the medical record)
• Spreadsheetlike record of nonanalgesic methods (spreadsheet maintained by researcher)
• Paired t-test for within group and independent t-test for comparison between experimental and control groups

• At baseline and after day 7, authors observed no significant difference between control group and experimental group in regard to pain (P > 0.05). However, in terms of frequency, the experimental group used significantly more analgesics and more nonpharmacologic strategies (P > 0.05). The group that received the pain management program (PMP) increased use of nonpharmacologic strategies (p < 0.05, mean = 0.75 [SD = 0.72]). Authors noted significant post-PMP differences in analgesic use (p < 0.05), with more analgesics used in the PMP group (analgesics mean = 1.15 [SD = 0.81]).  
• BQT results reflected a significant change (P < 0.05) in the experimental group in six of eight measures. The change could mean that participants felt more empowered in their handling of pain and use of pharmacologic and nonpharmacologic pain strategies.
• The pain scores of both groups decreased, although authors noted no significant difference between the decrease in each group (P > 0.05). However, the experimental group significantly increased its use of analgesics and nonpharmacologic strategies and reduced barriers to pain management.

Development and implementation of a pain management education program directed at reducing patient barriers and misconceptions about pharmacologic and nonpharmacologic strategies may help increase a patient's sense of empowerment regarding pain management.

• The study had a small sample, with fewer than 100 patients. Authors did not cite a power analysis of sample size.
• Analgesic dosing was not consistently tracked and recorded.
   

Pain education for patients is recommended.