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A Randomized Clinical Trial of the Efficacy of a Self-care Intervention to Improve Cancer Pain Management

Rustøen, Tone PhD, RN; Valeberg, Berit T. PhD, RN; Kolstad, Eva RN; Wist, Erik MD, PhD; Paul, Steven PhD; Miaskowski, Christine PhD, RN, FAAN

doi: 10.1097/NCC.0b013e3182948418

Background: The undertreatment of cancer pain remains a significant clinical problem.

Objective: The aim of this randomized controlled trial was to evaluate the efficacy of the PRO-SELF Pain Control Program that was modified for Norwegian cancer patients in decreasing pain and increasing opioid intake compared with control care.

Interventions/Methods: Oncology outpatients with pain from bone metastasis were randomized into the PRO-SELF (n = 87) or control (n = 92) groups. A nurse visited patients in the PRO-SELF group in their home at weeks 1, 3, and 6 and conducted telephone interviews at weeks 2, 4, and 5. Patients in both groups completed a daily diary of pain intensity ratings and analgesic intake.

Results: For both groups, significant decreases in pain intensity scores and in hours per day in pain (both, P < .001) were found over the 6 weeks of the study. However, no significant group × time interactions were found for any of the pain measures. In both groups, total dose of opioid taken increased over time. However, no significant group × time interactions were found for changes over time in the total dose, around-the-clock dose, or as-needed dose of opioid analgesics taken.

Conclusions: Possible reasons for the lack of efficacy include an inadequate dose of the psychoeducational intervention, inadequate changes in analgesic prescriptions, and/or the impact of attention provided to the control group.

Implications for Practice: Coaching, nursing support, and the use of a pain diary may be important interventions to reduce pain intensity.

Author affiliations: Division of Emergencies and Critical Care, Department of Research and Development (Dr Rustøen), and Cancer Clinic (Ms Kolstad and Dr Wist), Oslo University Hospital, Ullevål; Institute of Health and Society, Department of Nursing Science, University of Oslo (Dr Rustøen); Oslo University College, Faculty of Nursing (Dr Valeberg), Norway; and Department of Physiological Nursing, University of California, San Francisco (Drs Paul and Miaskowski).

The study was partially funded by the Research Council of Norway and Oslo University College.

The authors have no conflicts of interest to disclose.

Correspondence: Tone Rustøen, PhD, RN, Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Norway (

Accepted for publication March 21, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins