Background Pain can often be managed by tailoring opioid and adjuvant medications to individual patients, however, residual uncontrolled pain may benefit from a pain team intervention (e.g. localised block or epidural). Existing standards highlight the need for closer integration between pain and palliative care services (Raphael, Hester, Ahmedzai, et al., 2010. Pain Medicine. 11: 872) but evidence is lacking on how to establish this and the efficacy of such interventions.
Aim Service evaluation to assess outcome data for interventions delivered by a visiting pain team service at the hospice over the past three years.
Method Literature review and discussion with experts to finalise methodology. Identification of patients, retrospective data extraction from electronic records (January 2019-January 2022) including demographics, performance status, pain IPOS scores, opioid use (baseline, post-procedure, day 5-10) and complications.
Results Over three years, 67 patients received an intervention (51% female, 93% primary cancer diagnosis). Median (range) baseline opioid doses were 295mg (0-2480) morphine equivalent; the majority alongside multiple adjuvant analgesics. The 79 interventions included: 29 nerve blocks, 31 single-shot epidurals, 9 indwelling epidurals, 5 trigger point injections, 2 intrathecals, 3 others. 70 procedures occurred on the hospice in-patient unit, 6 in outpatients and 3 on home visits.
Paired pain IPOS scores, before and day after procedure, were recorded in 55/79 and 40% demonstrated improvement. This increased to 70% at 5-10 days after procedure (n= 54, 2 had died). Of the 63/79 who had paired results to calculate change in opioid use pre and five days post procedure, 52% had a reduction in dose. There was no change in numbers of adjuvant medications used. There were 8 common complications, 4 related to indwelling epidurals; 3 requiring termination of epidural.
Conclusion Evaluation of a pain team regularly reviewing patients in a hospice, with administration of interventional blocks/infusions, shows procedures were safe with a positive impact on patient outcomes. This data will inform a prospective study to further evaluate patient outcomes and develop this service.
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