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Pain prevalence and pain relief in end-of-life care - a national registry study

Hedman, Christel LU ; Fürst, Per ; Strang, Peter ; Schelin, Maria E C LU orcid ; Lundström, Staffan and Martinsson, Lisa (2024) In BMC Palliative Care 23. p.1-8
Abstract

BACKGROUND: Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce.

METHODS: The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used.

RESULTS: A total of 315 000 patients were included in the... (More)

BACKGROUND: Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce.

METHODS: The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used.

RESULTS: A total of 315 000 patients were included in the study. Pain during the last week of life was more commonly seen in cancer (81%) than in dementia (69%), heart failure (68%) or COPD (57%), also when controlled for age and sex, p < 0.001. Severe forms of pain were registered in 35% in patients with cancer, and in 17-21% in non-cancer patients. Complete pain relief (regardless of pain intensity) was achieved in 73-87% of those who experienced pain, depending on diagnosis. The proportion of patients with complete or partial pain relief was 99.8% for the whole group.

CONCLUSIONS: The occurrence of pain, including severe pain, was less common in patients with heart failure, COPD or dementia, compared to patients with cancer. Compared with cancer, pain was more often fully relieved for patients with dementia, but less often in heart failure and COPD. As severe pain was seen in about a third of the cancer patients, the study still underlines the need for better pain management in the imminently dying.

TRIAL REGISTRATION: No trial registration was made as all patients were deceased and all data were retrieved from The Swedish Register of Palliative Care database.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Registries/statistics & numerical data, Female, Sweden, Aged, Terminal Care/methods, Aged, 80 and over, Prevalence, Pain Management/methods, Middle Aged, Pain/etiology, Neoplasms/complications, Pulmonary Disease, Chronic Obstructive/complications, Adult, Pain Measurement/methods, Heart Failure/complications, Palliative Care/methods, Logistic Models
in
BMC Palliative Care
volume
23
article number
171
pages
1 - 8
publisher
BioMed Central (BMC)
external identifiers
  • pmid:39004730
  • scopus:85198508396
ISSN
1472-684X
DOI
10.1186/s12904-024-01497-1
language
English
LU publication?
yes
additional info
© 2024. The Author(s).
id
db6241d7-692f-4b3f-a7f0-38e20959db67
date added to LUP
2024-08-28 12:29:48
date last changed
2024-08-29 04:01:14
@article{db6241d7-692f-4b3f-a7f0-38e20959db67,
  abstract     = {{<p>BACKGROUND: Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce.</p><p>METHODS: The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used.</p><p>RESULTS: A total of 315 000 patients were included in the study. Pain during the last week of life was more commonly seen in cancer (81%) than in dementia (69%), heart failure (68%) or COPD (57%), also when controlled for age and sex, p &lt; 0.001. Severe forms of pain were registered in 35% in patients with cancer, and in 17-21% in non-cancer patients. Complete pain relief (regardless of pain intensity) was achieved in 73-87% of those who experienced pain, depending on diagnosis. The proportion of patients with complete or partial pain relief was 99.8% for the whole group.</p><p>CONCLUSIONS: The occurrence of pain, including severe pain, was less common in patients with heart failure, COPD or dementia, compared to patients with cancer. Compared with cancer, pain was more often fully relieved for patients with dementia, but less often in heart failure and COPD. As severe pain was seen in about a third of the cancer patients, the study still underlines the need for better pain management in the imminently dying.</p><p>TRIAL REGISTRATION: No trial registration was made as all patients were deceased and all data were retrieved from The Swedish Register of Palliative Care database.</p>}},
  author       = {{Hedman, Christel and Fürst, Per and Strang, Peter and Schelin, Maria E C and Lundström, Staffan and Martinsson, Lisa}},
  issn         = {{1472-684X}},
  keywords     = {{Humans; Male; Registries/statistics & numerical data; Female; Sweden; Aged; Terminal Care/methods; Aged, 80 and over; Prevalence; Pain Management/methods; Middle Aged; Pain/etiology; Neoplasms/complications; Pulmonary Disease, Chronic Obstructive/complications; Adult; Pain Measurement/methods; Heart Failure/complications; Palliative Care/methods; Logistic Models}},
  language     = {{eng}},
  month        = {{07}},
  pages        = {{1--8}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Palliative Care}},
  title        = {{Pain prevalence and pain relief in end-of-life care - a national registry study}},
  url          = {{http://dx.doi.org/10.1186/s12904-024-01497-1}},
  doi          = {{10.1186/s12904-024-01497-1}},
  volume       = {{23}},
  year         = {{2024}},
}