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Cancer patients' satisfaction with primary care pain management hinges on the doctor-patient relationship

A new study shows that more than 75 percent of cancer patients were satisfied with how their primary care doctors managed pain associated with their cancer and its treatment. This was despite the fact that nearly half of them suffered from recent moderate to severe pain. Long-term pain relief seemed more important for these patients. Sustained pain relief over the past year, being told by the primary care doctor or nurse that treating pain was an important goal, and patient willingness to take prescribed opioids for pain relief (suggesting a trusting doctor-patient relationship) all predicted greater patient satisfaction with pain management.

The doctor-patient relationship clearly plays a key role in patient satisfaction with pain management, according to the researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS08691). The researchers analyzed data on 316 primary care cancer patients' patterns of pain and pain treatment, beliefs and expectations about pain and pain relief, willingness to report pain and take pain medication, care from the provider, and satisfaction with pain management.

Among the cancer patients studied, who potentially faced long-term pain, sustained pain relief during the past year rather than most recent pain was most predictive of their satisfaction with pain management. Lowered expectations of pain relief, reflected by statements like "pain medicine cannot really control pain," predicted lower satisfaction either overall or with the primary care doctor. Patients who reported more frequent pain, indicating that their pain was not adequately managed, were less satisfied with pain management. Among patients who received pain medication, satisfaction was inversely correlated with discrepancies between expected and reported levels of pain either before or after another dose of medication.

More details are in "Probing the paradox of patients' satisfaction with inadequate pain management," by Ree Dawson, Ph.D., Judith A. Spross, Ph.D., R.N., Erica S. Jablonski, M.A., and others in the March 2002 Journal of Pain and Symptom Management 23(3), pp. 211-220.

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