Longitudinal Pain Reports in a Palliative Care Population

摘要

Background: The experiences of people with pain under palliative care is not well documented longitudinally. This work aims to describe the prevalence, intensity, progression, and associations of self-reported pain scores of people under a community palliative care service, by retrospectively examining how routinely collected pain scores changed over time. Methods: Pain was subcategorized depending on intensity, allowing group differences to be explored using analysis of variance. Bivariate analysis was used to explore the relationship between pain scores and other symptoms using Spearman’s Rho correlation. Results: Over two years, 3027 patients were seen, with data collected an average of 17.3 times (52,387 data points). At referral, 50% (n=1402) were pain free. Of those with pain, mean score was 2 (range 0–10). The majority had cancer (90%), with no signi?cant difference between the severity of reported pain scores between cancer and nonmalignant diagnoses (P=0.27). A signi?cant gender difference was noted, with females statistically more likely to report severe pain (v2 (3026)=5.61, p=0.018). Similarly, those <60 years were more likely to report pain v2(3025)=3.07; p=0.022). Longitudinal changes in pain revealed the pain scores of people admitted with pain <7 always reported lower pain scores than those with severe pain on admission (90 days, F(1, 654)=55.72, p<0.001; 60 days, F(1, 1008)=48.62, p<0.001; 30 days, F(1, 1522)=60.36, p<0.001; 7 days, F(1, 1897)=15.4, p<0.001). However, pain scores of those with pain <7 on admission rose as death approached compared with those who reported severe pain. Conclusion: Even in the context of expert delivery of palliative care where pain is most likely to be optimally managed, pain continues to be a problem. Work such as this suggests that the different mechanisms that contribute to pain may in?uence patients’ experiences even when analgesia is optimized in a specialist setting. Particular attention is needed in the future to explore the relationship between severe pain and mobility.