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Good…but Bad News
To the Editor:
We read with interest the paper by Greco et al.1
The authors conclude that that cancer pain management is improving.
After analyzing the literature in two different periods,
they have found a better quality of cancer pain
management reported in the last 6 years. While all researchers and
clinicians
would be happy with better quality of cancer pain
management, the bad news is that this conclusion is not accurate based
on
the parameters compared by the authors.
The Pain Management Index (PMI) score continues to be used inappropriately as an indirect measure of quality of pain management.2
The achievement of an appropriate analgesic treatment cannot be based
on this score, calculated by drug class and pain intensity.
This index was originally developed by Cleeland et
al3
to measure physicians' response to patients' pain, which is a generic
attitude in prescription, including for example drugs
prescribed but not necessary administered. Thus,
PMI does not provide any measure of adequacy of a pain treatment. With
this
score any patient receiving the class of strong
opioids is considered adequately treated and there is no consideration
of
pain intensity, opioid type, or even opioid dose.4.......Authors' Response
We appreciate the interest of Mercadante and Bruera1 in our article.2 They raise two important issues: first, the Pain Management Index (PMI) as a tool to measure the appropriateness of cancer
pain management, and second, the role of early palliative care in the management of patients with cancer.
We knew that the PMI, exclusively calculated
on pain intensity and class of drug given, would create discussion and
we expected
that our work would have raised interest because in
the last few years an increased attention in the role of opioids for
cancer
pain treatment was detected.....REFERENCES
- (2014) Quality of cancer pain management: An update of a systematic review of under treatment of patients with cancer. J Clin Oncol 32:4149–4154.
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