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Clinical Decisionmaking

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Patients' beliefs are not an important barrier to effective pain management

Cancer patients, many of whom are now treated in primary care offices, suffer both from cancer pain and from pain not related to cancer or its treatment. A recent study supported in part by the Agency for Healthcare Research and Quality (HS08691) examined the role of patients' beliefs in pain management. Results suggest that provider practices are more likely than patient beliefs to determine the level of pain relief achieved. In particular, the most important determinant of patients' recent pain was whether they experienced sustained relief when treated for pain.

To explore the role of patients' beliefs in pain management, the researchers studied 342 cancer patients seen by primary care providers in eight clinics in a managed care system. The patients complained of pain that would not dissipate on its own or when treated by over-the-counter medication. About half of the patients suffered from pain that was not cancer-related, such as arthritis pain.

Patients' beliefs were not associated strongly with reporting pain or taking medication and played a limited role in predicting recent pain intensity. The providers' pain management practices, however, seemed to have a far greater predictive role. For patients with moderate to severe pain, the association between their beliefs and their history of pain and pain treatment suggests that beliefs are likely to be formed partly as a consequence of the care they receive. The results did not depend on whether the cause of pain was related to cancer.

See "Do patients' beliefs act as barriers to effective pain management behaviors and outcomes in patients with cancer-related or noncancer-related pain?" by Ree Dawson, Ph.D., Deborah E. Sellers, Ph.D., Judith A. Spross, Ph.D., R.N., A.O.C.N.®, F.A.A.N., and others, in the Oncology Nursing Forum 32(2), pp. 363-374, March 2005.

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