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Dying With Unrelieved Pain-Prescription of Opioids Is Not Enough

Klint, Åsa ; Bondesson, Elisabeth LU orcid ; Rasmussen, Birgit H LU ; Fürst, Carl Johan LU and Schelin, Maria E C LU orcid (2019) In Journal of Pain and Symptom Management 58(5). p.1-791
Abstract

CONTEXT: Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain.

OBJECTIVES: We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study.

METHODS: Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011-2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved... (More)

CONTEXT: Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain.

OBJECTIVES: We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study.

METHODS: Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011-2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved pain.

RESULTS: Unrelieved pain during the final week of life was reported for 25% of the patients with pain, despite prescription of opioids PRN in 97% of cases. Unrelieved pain was common both among patients dying of cancer and of nonmalignant chronic diseases. Statistically significant risk factors for unrelieved pain included hospital death (RR = 1.84, 95% CI 1.79-1.88) compared with dying in specialist palliative care, absence of an EoL conversation (RR = 1.42, 95% CI 1.38-1.45), and dying of cancer in the bones (RR = 1.13, 95% CI 1.08-1.18) or lung (RR = 1.10, 95% CI 1.06-1.13) compared with nonmalignant causes.

CONCLUSION: Despite almost complete prescription of opioids PRN for patients with pain, patients die with unrelieved pain. Health care providers, hospitals in particular, need to focus more on pain in dying patients. An EoL conversation is one achievable intervention.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Pain and Symptom Management
volume
58
issue
5
pages
1 - 791
publisher
Elsevier
external identifiers
  • scopus:85070707918
  • pmid:31319106
ISSN
1873-6513
DOI
10.1016/j.jpainsymman.2019.07.006
language
English
LU publication?
yes
additional info
Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.
id
d4c88bbe-68fe-465e-99c7-74ea99084322
date added to LUP
2019-10-28 11:03:13
date last changed
2025-01-10 01:09:50
@article{d4c88bbe-68fe-465e-99c7-74ea99084322,
  abstract     = {{<p>CONTEXT: Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain.</p><p>OBJECTIVES: We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study.</p><p>METHODS: Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011-2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved pain.</p><p>RESULTS: Unrelieved pain during the final week of life was reported for 25% of the patients with pain, despite prescription of opioids PRN in 97% of cases. Unrelieved pain was common both among patients dying of cancer and of nonmalignant chronic diseases. Statistically significant risk factors for unrelieved pain included hospital death (RR = 1.84, 95% CI 1.79-1.88) compared with dying in specialist palliative care, absence of an EoL conversation (RR = 1.42, 95% CI 1.38-1.45), and dying of cancer in the bones (RR = 1.13, 95% CI 1.08-1.18) or lung (RR = 1.10, 95% CI 1.06-1.13) compared with nonmalignant causes.</p><p>CONCLUSION: Despite almost complete prescription of opioids PRN for patients with pain, patients die with unrelieved pain. Health care providers, hospitals in particular, need to focus more on pain in dying patients. An EoL conversation is one achievable intervention.</p>}},
  author       = {{Klint, Åsa and Bondesson, Elisabeth and Rasmussen, Birgit H and Fürst, Carl Johan and Schelin, Maria E C}},
  issn         = {{1873-6513}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{5}},
  pages        = {{1--791}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Pain and Symptom Management}},
  title        = {{Dying With Unrelieved Pain-Prescription of Opioids Is Not Enough}},
  url          = {{http://dx.doi.org/10.1016/j.jpainsymman.2019.07.006}},
  doi          = {{10.1016/j.jpainsymman.2019.07.006}},
  volume       = {{58}},
  year         = {{2019}},
}