Clinical and Demographic Characteristics Help Explain Variations in Pain at the End of Life

Abstract The natural history of pain at the end of life is not well understood. The purpose of this study was to estimate the association between clinical and demographic characteristics and pain in persons who received hospice care in the United States. Data for this study were obtained from a nati...

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Bibliographic Details
Published in:Journal of pain and symptom management 2008, Vol.35 (1), p.10-19
Main Authors: Strassels, Scott A., PharmD, PhD, BCPS, Blough, David K., PhD, Veenstra, David L., PharmD, PhD, Hazlet, Thomas K., PharmD, DrPH, Sullivan, Sean D., PhD
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Anesthesia & Perioperative Care
Biological and medical sciences
Data Interpretation, Statistical
Female
hospice
Hospices
Humans
Length of Stay
Life Change Events
Male
Medical sciences
Middle Aged
Pain
Pain - epidemiology
Pain - etiology
Pain Medicine
Palliative Care
Pharmacology. Drug treatments
regression
United States
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Summary:Abstract The natural history of pain at the end of life is not well understood. The purpose of this study was to estimate the association between clinical and demographic characteristics and pain in persons who received hospice care in the United States. Data for this study were obtained from a national provider of hospice pharmacy services and included information about the hospice and person receiving hospice care, including geographic location, primary diagnoses, pain intensity, and opioid analgesic use. The data were collected from 2000 to 2004. Worst pain intensity during the previous 24 hours was assessed by the hospice nurse using a 0–10 numeric rating scale (0 = none, 10 = worst) at an average of 4.1 times per person during hospice care. Regression models were constructed to explain last and average pain scores using data from persons with at least two pain intensity scores. Hospice services were provided to 51,578 persons with at least two pain intensity scores. Of this cohort, 52% were female, 87.5% were Caucasian, and 66.4% had a primary diagnosis of cancer. The mean age at discharge or death was 73.8 years. Patient characteristics accounted for nearly one-third and nearly one-half of the variability in last and average pain scores, respectively. Severe pain on admission and frequency of pain reports were associated with less intense pain. Clinical and demographic characteristics contributed to identifying persons who had severe pain during their hospice admission. These data contribute to understanding pain in persons at the end of life.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2007.02.036