Procedural pain in patients with cancer: a Delphi expert management consensus
Por:
Estevez F, Alarcon M, Beato C, Sanz-Yague A, Porta-Sales J, Lopez R
Ahead of Print:
1 jun 2021
Resumen:
Objectives Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer. Methods Using a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median. Results With an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients. Conclusions These results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.
Filiaciones:
Estevez F:
Consorcio Hosp Prov Castellon, Unidad Dolor Pain United, Castellon de La Plana, Spain
Alarcon M:
Hosp Gen Univ Valencia, Unidad Dolor, Valencia, Spain
Beato C:
Hosp Univ Jerez Frontera, Dept Oncol Med, Jerez de la Frontera, Spain
Sanz-Yague A:
Kyowa Kirin Farmaceut SLU, Dept Med, Madrid, Spain
Porta-Sales J:
Inst Catala Oncol, Unidad Cuidados Paliat, Girona, Spain
Lopez R:
Hosp Univ La Paz, Serv Oncol Radioterap, Madrid, Spain
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