J E Williams1, J Peacock2, A N Gubbay3, P Y Kuo3, R Ellard3, R Gupta3, J Riley4, O Sauzet5, J Raftery6, G Yao7, J Ross8. 1. Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK john.williams@rmh.nhs.uk. 2. Division of Health and Social Care Research, King's College, London, UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, and King's College, London, UK. 3. Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK. 4. Department of Palliative Medicine, Royal Marsden NHS Foundation Trust, London, UK. 5. AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld, Germany. 6. Dept. of Health Economics, University of Southampton, UK. 7. Department of Primary Care and Population Science, University of Southampton, UK. 8. Department of Palliative Medicine, Royal Marsden NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK.
Abstract
BACKGROUND: We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancer patients with significant pain. METHODS: Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months. RESULTS: We screened 1074 patients of whom 156 were randomized to eitherintervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P<0.001), as was Patient Satisfaction (mean difference in scores was statistically significant: -0.30 [-0.60 to -0.15]). All subjects reported clinically significant levels of anxiety and depression throughout the study. Treatment costs were significantly higher for intervention (mean=£400) compared with usual care (£200), with a low likelihood of being cost-effective. CONCLUSIONS: There was no difference in the Pain Severity Index between the two groups. However there were significant improvements in the intervention group in patient satisfaction and PMI. The pain screening process itself was effective. Sufficient benefit was demonstrated as a result of the intervention to allow continued development of pain treatment pathways, rather than allowing pain treatment to be left to nonformalised ad hoc arrangements.
RCT Entities:
BACKGROUND: We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancerpatients with significant pain. METHODS:Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months. RESULTS: We screened 1074 patients of whom 156 were randomized to either intervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P<0.001), as was Patient Satisfaction (mean difference in scores was statistically significant: -0.30 [-0.60 to -0.15]). All subjects reported clinically significant levels of anxiety and depression throughout the study. Treatment costs were significantly higher for intervention (mean=£400) compared with usual care (£200), with a low likelihood of being cost-effective. CONCLUSIONS: There was no difference in the Pain Severity Index between the two groups. However there were significant improvements in the intervention group in patient satisfaction and PMI. The pain screening process itself was effective. Sufficient benefit was demonstrated as a result of the intervention to allow continued development of pain treatment pathways, rather than allowing pain treatment to be left to nonformalised ad hoc arrangements.
Authors: Natalie Pattison; Matthew Rd Brown; Anthony Gubbay; Janet Peacock; Joy R Ross; Suzanne Chapman; Odile Sauzet; John Williams Journal: Br J Pain Date: 2015-09-23
Authors: Jessica R Bauman; Jessie R Panick; Thomas J Galloway; John A Ridge; Marcin A Chwistek; Molly E Collins; Leigh Kinczewski; Kathleen Murphy; Marie Welsh; Matthew A Farren; Mollie Clark Omilak; Jacqueline Kelly; Katherine A Schuster; Lauren A Lucas; Sheila Amrhein; Florence P Bender; Jennifer S Temel; Brian L Egleston; Areej El-Jawahri; Carolyn Y Fang Journal: J Palliat Med Date: 2021-04-13 Impact factor: 2.947
Authors: Melanie R Lovell; Jane L Phillips; Tim Luckett; Lawrence Lam; Frances M Boyle; Patricia M Davidson; Seong L Cheah; Nicola McCaffrey; David C Currow; Tim Shaw; Annmarie Hosie; Bogda Koczwara; Stephen Clarke; Jessica Lee; Martin R Stockler; Caitlin Sheehan; Odette Spruijt; Katherine Allsopp; Alexandra Clinch; Katherine Clark; Alison Read; Meera Agar Journal: JAMA Netw Open Date: 2022-02-01
Authors: Eugenie Younger; Olga Husson; Lindsey Bennister; Jeremy Whelan; Roger Wilson; Andy Roast; Robin L Jones; Winette Ta van der Graaf Journal: BMC Cancer Date: 2018-10-17 Impact factor: 4.430
Authors: Michael I Bennett; Elon Eisenberg; Sam H Ahmedzai; Arun Bhaskar; Tony O'Brien; Sebastiano Mercadante; Nevenka Krčevski Škvarč; Kris Vissers; Stefan Wirz; Chris Wells; Bart Morlion Journal: Eur J Pain Date: 2019-01-06 Impact factor: 3.931