Oldenmenger, W.H., Sillevis Smitt, P.A., van Montfort, C.A., de Raaf, P.J., & van der Rijt, C.C. (2011). A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: A  randomized controlled trial. Pain, 152(11), 2632–2639.

To test the effect, on pain severity and interference with daily life, of standard care versus care supplemented with pain education

Patients were referred by primary care providers and randomly assigned to the pain education program or standard care. The education intervention was provided in clinics and by telephone. Intervention included enhancing knowledge about pain and pain treatment.  Patients were contacted weekly by telephone. During each call they reviewed pain outcomes and side effects and received reinforcement education as necessary. In the report of the study, authors did not described standard care. The study was conducted over eight weeks. The study was originally designed to evaluate three groups; however, because of low recruitment the study compared only two interventions.

• The sample was composed of 59 patients. 
• Mean patient age was 59 years (SD = 11 years).
• Of all patients, 35% were male and 65% were female.
• The sample included patients with various tumor types; 82% of patients had metastatic disease.
• Average duration of pain was five months. All patients had nociceptive pain.
   

• Single site
• Outpatient
• Rotterdam, the Netherlands

Phases of care: multiple phases of care

Randomized controlled trial

• Brief Pain Inventory
• World Health Organization analgesic ladder (step scale)
• Pain management index
• Medication Event Monitoring Systems (MEMSs)
   

Average reduction in pain intensity declined in both groups. The decline was 0.8 (20%) greater in those receiving the intervention program (p = 0.03) than in those receiving standard care. Pain-related interference declined more in the intervention group (p < 0.01).  In the group that received the intervention, the percentage of patients who received both round-the-clock and as-needed medication increased: Of those receiving the intervention, 88% changed to this approach. In the group receiving standard care, 50% changed to the approach (p = 0.003). Adherence was initially the same across both groups. In the last two weeks, however, adherence was 74% in the standard-care group and 85% in the intervention group (p = 0.028).

The educational and support intervention was associated with greater decline in pain severity and pain-related interference, more aggressive pharmacologic management, and slightly better patient adherence over an eight-week period.

• The study had a small sample, with fewer than 100 participants.
• The study had a risk of bias due to no blinding.
• Authors noted that the study was underpowered.

Findings from this study support evidence that psychoeducational interventions can improve pain management and pain outcomes in patients with cancer-related pain. Incorporating such interventions and related follow-up programs into nursing practice can greatly benefit patients with chronic pain.