Assessment of pain and patterns of analgesic use in hospice patients

The purpose of this study is to describe patterns of pain, analgesic use, barriers to pain control, and various aspects of lifestyle affected by pain in hospice patients. Seventy-six charts of deceased patients were randomly selected of patients who had received care from Hospice of Wake County between August 1990 and August 1991. All patient's charts were reviewed from date of entry into hospice until death. Pain assessments were routinely performed at entry into hospice, then at one month intervals, and, thereafter, whenever a change in pain status occurred. The average number of pain assessments performed per patient was 2.7 (range 18). Pain intensity score increased as the number of pain assessments increased. Pain was described as occasional (25.2 percent), frequent (26.6 percent) or constant (24.1 percent). Most common analgesic medications were long-acting morphine sulphate (25.4 percent), acetaminophen and hydroxy/oxycodone combinations (20.1 percent) and NSAIDS (17.1 percent). Approximately 40 percent of all pain assessments reflected use of greater than one analgesic agent and prn and scheduled medications simultaneously. Eighty percent of all pain assessments prompted a recommendation to change the analgesic regimen and 62.5 percent of regimen changes were associated with improvement in pain status. Barriers to pain control and lifestyle alterations due to pain were identified. The positive findings in this report, compared to previous similar investigations, supports the use of the pain assessment document and guidelines for cancer pain management in use at the Hospice of Wake County.