Williams, J.E., Peacock, J., Gubbay, A.N., Kuo, P.Y., Ellard, R., Gupta, R., . . . Ross, J. (2015). Routine screening for pain combined with a pain treatment protocol in head and neck cancer: A randomised controlled trial. British Journal of Anaesthesia, 115, 621–628.
To compare the effectiveness of a pain management protocol with usual care
Patients who were referred for pain control were screened for worst pain severity on a 10-point numerical scale, and those who scored four or more were randomized to usual care or the experimental protocol group. The protocol treatment was individualized to the patient based on assessments. Protocols included the formulation of a pain treatment plan, weekly reassessments, the provision of an educational brochure, a discussion with a pain control doctor, and a referral to palliative care or other services as needed. Patients were followed for three months. Usual care patients could be referred to the pain control group but were not proactively scheduled for ongoing weekly assessments. Study assessments were done at baseline and at one and two months.
Single-blinded, randomized, controlled trial
There were no significant differences between the groups in pain measures throughout the study. Patient satisfaction was higher in the study group. The mean cost of pain treatment was significantly higher in the study group. The analysis showed a low probability of the intervention being cost-effective. Pain scores declined significantly over time in both groups.
The protocol did not demonstrate any significant benefit over usual care.
The findings of this study did not show a benefit of the specific protocol approach with weekly reassessments in the clinic as used here. This study did show that pain screening could be implemented and combined with good usual care to reduce pain severity.