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Quality of cancer pain management: an update of a systematic review of undertreatments of patients with cancer

Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G.

J Clin Oncol 2014; 32: 4149-54

Editors‘ comment: Dr. Carla Ripamonti

The American Pain Society defined pain as the 5th vital sign. Unfortunately the undertreatment of pain in oncologic setting is reported in many studies. The Pain Management Index (PMI) by Cleeland is defined as “an index that substracts the patient’s rating of pain from the rating of the strongest analgesic agent” and a negative score defines the undertreatment of pain.
A systematic review covering 26 studies from 1994 until 2007 and published in 2008, assessing the adequacy of pharmacologic pain therapy, reported the rate of potentially undertreated patient cases from 8% to 82% with a mean of 43.4%. The authors updated the systematic review of 2008 with a new set of 20 articles published from 2007 to 2013. According to the PMI, the undertreatment of pain decreased of about 25% (from 43.4 to 31.8%). Articles published more recently showed a tendency toward a lower prevalence of undertreatment. Non-specific settings of care and lower economic level were the only variables with an important significant association with PMI scores.
However, approximately one third of patients still do not receive pain medication according to their pain intensity.

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