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Original research
Procedural pain in patients with cancer: a Delphi expert management consensus
  1. Francisco J Villegas Estévez1,
  2. Maria Dolores López Alarcón2,
  3. Carmen Beato3,
  4. Almudena Sanz-Yagüe4,
  5. Josep Porta-Sales5 and
  6. Rosa M Morera López6
  1. 1 Unidad del Dolor Pain United, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain
  2. 2 Unidad del Dolor, Hospital General Universitario de Valencia, Valencia, Spain
  3. 3 Departamento de Oncología Médica, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
  4. 4 Departamento Médico, Kyowa Kirin Farmacéutica S.L.U, Madrid, Spain
  5. 5 Unidad de Cuidados Paliativos, Institut Catalá d'Oncologia, Girona, Spain
  6. 6 Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
  1. Correspondence to Dr Francisco J Villegas Estévez, Unidad del Dolor Pain United, Consorcio Hospitalario Provincial de Castellón, Castellon de la Plana 12002, Spain; franvilles{at}hotmail.com

Abstract

Objectives Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer.

Methods Using a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7–9), uncertain (4–6) or inappropriate (1–3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median.

Results With an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients.

Conclusions These results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.

  • pain
  • cancer
  • hospital care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. The authors confirm that all data supporting the findings of this study are available within the article and its supplemental materials.

https://doi.org/10.1136/bmjspcare-2020-002668

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information. The authors confirm that all data supporting the findings of this study are available within the article and its supplemental materials.

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    Footnotes

    • Contributors All authors had contributed to the study conception and design as well as to material preparation and data collection, which was critically revised for important intellectual content. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved.

    • Funding Kyowa Kirin Farmacéutica sponsored the creation and maintenance of the project.

    • Disclaimer The funders participated in the design of the study.

    • Competing interests The following authors received honoraria for consultancy and/or lectures: FVE from Kyowa Kirin Farmacéutica, Grunenthal, Gebro Pharma, Ferrer and Mylan; MDLA from Kyowa Kirin Farmacéutica, Takeda, Gebro Pharma, Lab Esteve, Teva and Grunenthal; CB from Kyowa Kirin Farmacéutica, Ferrer and Angelini; JPS from Kyowa Kirin Farmacéutica and Ferrer; RMML from Astellas and Janssen. AS-Y is an employee of Kyowa Kirin Farmacéutica.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.