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Kim, Koh, Kim, Kang, Noh, Kim, Kim, and Lee: Pain Management Based on NCCN Guideline in Patients with Lung Cancer
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(3): 221-225.

Published online: 30 September 2009

DOI: https://doi.org/10.4046/trd.2009.67.3.221

Pain Management Based on NCCN Guideline in Patients with Lung Cancer

Hyeon Tae Kim, M.D., Kyung Won Koh, M.D., Yeo Myeong Kim, M.D., Min Soo Kang, M.D., Hee Sun Noh, M.D., Hye-Ryoun Kim, M.D., Cheol Hyeon Kim, M.D., Jae Cheol Lee, M.D.

Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

Address for correspondence: Jae Cheol Lee, M.D. Department of Internal Medicine, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Phone: 82-2-970-1206, Fax: 82-2-970-2438, jclee@kcch.re.kr

Received 17 July 2009       Accepted 3 September 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Pain is one of the most troublesome problems caused by malignancy. We evaluated the change in pain status according to observance of NCCN guidelines in lung cancer patients.

Methods

Lung cancer patients complaining of pain at admission were examined. The pain was assessed with visual analogue scale (VAS) for 20 days and moderate-to-severe pain was defined as more than VAS level 3. The guideline observance was classified as high (more than 80%), medium (50~79%) and low (less than 50%).

Results

Among the total 91 lung cancer patients with pain, 34 patients (37%) had moderate-to-severe pain. Their average VAS score at admission was 5.6. It decreased to 2.9 after a 20-day period of pain management. The time to reach a VAS less than 3 was 3 days in a high guideline observance group, while it took 6 days in a low observance group. In addition, the pain in the high observance group was controlled to less than 3 VAS level in 86% of patients, whereas only 25% of patients in the low observance group succeeded.

Conclusion

Pain was more effectively controlled when the dose of drugs was modified according to NCCN guidelines in lung cancer patients indicating the importance of guideline observance in pain management.

Keywords: Pain, NCCN guideline, Lung neoplasms

Figures and Tables

Figure 1
The proportion of initial pain intensity at admission in lung cancer patients with pain (Mild; VAS 1~3, Moderate; VAS 4~6, Severe; VAS 7~9). VAS: visual analogue scale.
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Figure 2
The average VAS score 5.6 at admission decreased to 2.9 20 days after pain management and the dose of drug (TTS-fentanyl equivalent) increased from 63.8 to 105.5 mcg/h in patients with moderate-to-severe pain. VAS: visual analogue scale.
trd-67-221-g002
Figure 3
(A) The guideline observance rate. (B) The pain control rate to less than VAS score 3 according to the observance of guideline. (C) Time to reach VAS level 2 according to the observance of guideline. VAS: visual analogue scale.
trd-67-221-g003

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