Knowledge of pain management in patients with painful bone metastases: A multicentre randomized trial on pain education

Background: Education of patients regarding pain management may improve patient empowerment and, consequently, reduce pain intensity. To investigate the effect of education on pain intensity, a multicentre phase 3 study was conducted between 1-3-2011 and 1-4-2016. A total of 354 patients who received radiotherapy for painful bone metastases were randomized between nurse-led tailored education regarding pain management or care as usual. A worst pain score of ≥5 on a 0-10 numeric rating scale (NRS) was one of the inclusion criteria. The primary endpoint was pain intensity. Here we report on pain knowledge in patients randomized in the education arm. Methods: Patient characteristics, pain intensity (NRS) and patients' thoughts regarding pain management were assessed using a structured interview. This interview took place between randomization and start of radiotherapy. Patients were asked whether they completely agreed-completely disagreed on a 5 point Likert scale with the following statements 1) cancer pain can be relieved effectively 2) pain medication should be given only when pain is severe 3) most cancer patients will become addicted to pain medication 4) it is better to give the lowest amount of pain medication, so that larger doses can be used later if pain increases 5) it is better to give pain medication around the clock than only when needed 6) non-pharmacological interventions can relieve pain 7) patients are often overmedicated 8) use of pain medication can be changed without consulting a physician. Lack of knowledge was identified if they completely or fairly disagreed on statement 1, 5, 6 or, completely or fairly agreed on statement 2-4, 7 or 8. Results: 167 patients were interviewed, mean age 65 ±10 years. Mean worst pain at inclusion was 7.9 ±1.4. 52% of patients used strong opioids (WHO step 3). Most patients (91%) lacked knowledge of at least one statement (median 2, range 1-6). Lacks were found most frequently for statements 4 (69%), 2 (41%), 3 and 7 (both 28%). Patients' knowledge was best about statements 8 (77% disagreed), 5 (74% agreed) and 1 (73% agreed). Conclusions: Most patients lack sufficient knowledge on different topics of pain management, advocating tailored pain education