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Pain in Outpatients Treated for Breast Cancer: Prevalence, Pharmacological Treatment, and Impact on Quality of Life

Wu, Horng-Shiuann PhD, RN; Natavio, Teofanes MSN, RN; Davis, Jean E. PhD, RN; Yarandi, Hossein N. PhD

doi: 10.1097/NCC.0b013e3182664c95

Background: Cancer pain is an unmitigated clinical phenomenon. Despite available guidelines, variability exists in treating cancer pain.

Objective: The objective of this study was to describe prevalence and severity of pain and the pharmacotherapy (opioid, nonopioid, adjuvant analgesics) in outpatients treated for breast cancer. Adequacy of pharmacological pain treatments, the predictors, and impact were also examined.

Methods: This descriptive study consisted of 114 chemotherapy outpatients from urban and rural settings. Pain and quality of life were self-reported by patients; treatment-related information was obtained from medical records. Based on the World Health Organization analgesic ladder, adequacy of pharmacological pain management (acceptable or inadequate analgesia) was computed using the Pain Management Index; the most potent analgesic was prescribed relative to the patient’s reported pain.

Results: Although patients were commonly treated with traditional analgesics, more than half (52.3%) received inadequate analgesia. Those who received inadequate analgesia reported more pain, greater pain interferences (P = .003), and more symptoms (P = .043). Those who received adjuvant analgesics reported more pain, greater interference (P = .018), more symptoms (P = .032), and lower functioning (P = .029). Nonadvanced disease stages and more comorbidities were strong predictors of inadequate analgesia.

Conclusions: There is a lack of congruence between the strength of analgesia and the patient’s pain level. The addition of adjuvant analgesics did not reduce pain severity or improve quality of life.

Implications for Practice: The risks and benefits of coadministration of traditional and adjuvant analgesics need to be determined. Other treatment modalities in conjunction with pharmacological treatment are needed, considering negative effects of adjuvant analgesics on pain and quality of life.

Author Affiliations: College of Nursing, Wayne State University, Detroit, Michigan.

This study was funded by Oncology Nursing Foundation/Novartis Nursing Research Grant.

The authors have no conflicts of interest to disclose.

Correspondence: Horng-Shiuann Wu, PhD, RN, College of Nursing, Wayne State University, 5557 Cass Ave, Room #337 Cohn Bldg, Detroit, MI 48202 (

Accepted for publication June 19, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins