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Differences in Pain Location, Intensity, and Quality by Pain Pattern in Outpatients With Cancer

Ngamkham, Srisuda PhD, RN; Holden, Janean E. PhD, RN, FAAN; Wilkie, Diana J. PhD, RN, FAAN

doi: 10.1097/NCC.0b013e3181faab63

Background: Pain pattern represents how the individual's pain changes temporally with activities or other factors, but researchers have studied less the pattern of pain than its location, intensity, and quality parameters.

Objective: The aim of this study was to explore differences in pain location, intensity, and quality by pattern groups in outpatients with cancer.

Method: We conducted a comparative, secondary data analysis of data collected from 1994 to 2007. Seven hundred sixty-two outpatients with cancer completed the 0- to 10-point Pain Intensity Number Scale and the McGill Pain Questionnaire to measure pain location, quality and pattern. From all possible combinations of the 3 types of pain patterns, we created 7 pain pattern groups.

Results: Pain pattern group distribution was as follows: pattern 1 (27%), 2 (24%), 3 (8%), 4 (12%), 5 (3%), 6 (18%), and 7 (8%). A significant higher proportion of patients with continuous pain pattern (patterns 1, 4, 5, and 7) reported pain location in 2 or more sites. Patients with patterns 1, 4, and 7 reported significantly higher worst pain mean scores than did patients with patterns 2, 3, and 6. Patients with pattern 7 reported significantly higher mean scores for the Pain Rating Index-sensory and total number of words selected than did patients with patterns 1, 2, 3, 4, and 6.

Conclusions: Using pain pattern groups may help nurses to understand temporal changes in cancer pain and to provide more effective pain management, especially if the pain has a continuous component.

Implications for Practice: Nurses or clinicians who are taking care of patients with cancer should recognize that pain patterns are associated with pain location, intensity, and quality.

Author Affiliations: Phrapokklao Nursing College, Chanthaburi, Thailand (Dr Ngamkham); Division of Acute, Critical, and Long-term Care Programs, School of Nursing, University of Michigan, Ann Arbor (Dr Holden); and Department of Biobehavioral Health Science College of Nursing, University of Illinois at Chicago (Dr Wilkie).

This research was made possible by grants R29 CA62477, 2R01 CA62477, 1R01 CA81918, and 2 R01 CA081918 from the National Institutes of Health, National Cancer Institute, and grant RPG-96-001-03-PBP from the National Office of the American Cancer Society, and publication was supported by grant P30 NR010680 from the National Institute Nursing Research, all awarded to DrWilkie.

The contents of this research are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the American Cancer Society. The final peer-reviewed manuscript is subject to the National Institutes of Health Public Access Policy.

PAINReportIt is commercially available from Nursing Consult LLC (801-4140627). None of the authors have a financial interest in Nursing Consult LLC.

Correspondence: Diana J. Wilkie, PhD, RN, FAAN, Department of Biobehavioral Health Science (MC 802), College of Nursing, University of Illinois at Chicago, 845 S Damen Ave, Room 660, Chicago, IL 60612 (

Accepted for publication August 29, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.