***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Cancer pain is highly prevalent and commonly undertreated . This study was design ed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practice s. PATIENTS AND METHODS A pain management protocol was developed based on accepted guidelines . After baseline assessment , oncology practice s were r and omly assigned to ' analgesic protocol ' ( AP ) sites , where oncologists implemented the guidelines in a group of lung or prostate cancer patients , or to ' physician discretion ' ( PD ) sites , where customary treatment was continued . Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the  Brief Pain Inventory , and for change in other symptoms or mood . RESULTS The protocol terminated early because of poor accrual . We compared groups using proportions of patients who had no or mild pain at follow-up . Although measures of protocol adherence did not suggest the occurrence of major practice change , the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites . There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites . CONCLUSION A protocol for cancer pain management can improve pain control . Diffusion of these benefits to other patients was not confirmed . Given the small sample size , these findings require confirmation in a larger trial The problem of cancer-related pain afflicts millions of people annually . The study described here was aim ed at improving cancer patients '  pain control through a planned patient education program . A r and omized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed material s.  The sample included 230 cancer patients . One month later , patients in the experimental group were more likely to have taken their pain medicine on the correct schedule and to have taken the correct dosage . The experimental group also was significantly less likely to report stopping the medicine when they felt better . In addition , they were significantly less worried about tolerance and addiction to pain medicines . Forty-four percent of the experimental group compared to 24 % of the control group reported no or mild pain at the posttest The purpose of this r and omized controlled study was to assess the effects of a structured pain education program on the pain experience of hospitalized cancer patients . Eligible cancer pain patients were r and omly assigned to either an  experimental group ( receiving pain education 10–15 min per day for 5 days , n=15 ) or a st and ard care control group ( n=15 ) . The effects of the intervention on six pain-related variables were evaluated using three instruments . Pain intensity , pain interference with daily life , negative beliefs about opioids , beliefs about endurance of pain , pain catastrophizing ( an individual ’s tendency to focus on and exaggerate the threat value of painful stimuli and negatively evaluate his or her own ability to deal with pain ) , and sense of control over pain were evaluated by the Brief Pain Inventory — Short Form Taiwanese version ( BPI-T ) , Pain and Opioid Analgesic Beliefs Scale — Cancer ( POABS-CA ) , and the Catastrophizing subscale and the sense of control over pain measure from the Coping Strategies Question naire ( CSQ ) . The results indicated that , after completing treatment , patients who had received  structured pain education  had significantly less pain intensity on average , negative pain beliefs regarding opioids , pain endurance beliefs , and pain catastrophizing than patients in the control group . In addition , patients in the pain education group showed a significant increase in their sense of control over pain . These preliminary results strongly suggest that structured pain education can effectively improve the pain experience of hospitalized cancer patients and should be further implemented clinical ly Despite advances in the technology of cancer pain assessment and control , cancer pain often remains undertreated even in hospital setting s. To determine whether a graphical display of cancer patients ' pain levels might improve their treatment , the investigators conducted a r and omized controlled trial . Patients assigned to the intervention group ( N = 40 ) had periodic pain assessment s by study staff , who graphically recorded their reported pain-intensity levels on bedside wall charts . Control group patients ( N = 38 ) had periodic pain assessment s by study staff but did not have this information displayed . The results failed to show a significant beneficial effect of the intervention on pain control , sleep , cancer-related symptoms , or analgesic dosing , but confidence intervals were broad . More research is needed to improve the quality of care for in patients with cancer-related pain The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies . This r and omized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aim ed to optimize patients ' ability to manage pain . One week post-intervention , patients receiving the pain management intervention ( PMI ) had a significantly greater increase in self-reported pain knowledge , perceived control over pain , and number of pain treatments recommended . Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain , concerns about addiction and side effects , being a " good " patient , and tolerance to pain relieving medication . The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes , which can potentially act as barriers to effective pain management & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies PURPOSE To evaluate oncology out patients ' level of adherence to their analgesic regimen during a 5-week period . PATIENTS AND METHODS A r and om sample of 65 adult oncology out patients with a Karnofsky performance status score of > or= 50 , an average pain intensity score of > or= 2.5 , and radiographic evidence of bone metastasis were recruited for this longitudinal study from seven outpatient setting s. On a daily basis , patients rated their level of pain intensity and recorded pain medication intake . Adherence rates for opioid analgesics prescribed on an around-the-clock ( ATC ) and on an as-needed ( PRN ) basis were calculated on a weekly basis . RESULTS Overall adherence rates for ATC opioid analgesics ranged from 84.5 % to 90.8 % and , for PRN analgesics , from 22.2 % to 26.6 % . No significant differences over time were found in either of these adherence rates . CONCLUSION One factor that seems to contribute to ineffective cancer pain management is poor adherence to the analgesic regimen PURPOSE / OBJECTIVES To demonstrate the effects of a program , directed at homecare nurses , of structured educational interventions on the management of pain and opioid-related side effects in homecare patients with cancer . DESIGN A longitudinal multilevel , r and omized , controlled clinical trial . SETTING Midwestern region in the United States . SAMPLE 202 nurses caring for patients with cancer recruited from homecare agencies . METHODS The two-tiered educational program focused on basic and advanced pain management strategies , particularly in the area of pharmacologic options and assertive communication skills . Instruments used were the Nurses ' Knowledge and Attitudes Survey Regarding Pain , the barriers question naire , perception of control over pain , and a demographic question naire . MAIN RESEARCH VARIABLES Knowledge and attitudes about pain management , barriers to pain management , and perception of control over pain . FINDINGS Nurses in the intervention group had a significant increase in their knowledge , a more positive attitude about pain management , fewer perceived barriers to pain management , and an increase in perceived control over pain compared to the nurses who did not receive the intervention . CONCLUSIONS The educational program Power Over Pain has beneficial effects for homecare nurses caring for patients with cancer pain . IMPLICATION S FOR NURSING A need exists for homecare nurses to gain more insight into pain management strategies and enhance their advocacy skills to improve pain management for patients with cancer treated in the home & NA ; Two hundred and sixty‐three ambulatory patients older than 21 years of age who were attending clinics at an oncology hospital in San Juan , Puerto Rico , were studied . They completed a question naire  ( BQ‐PR ) that measures 8 concerns about reporting pain and using analgesics , such as fears of addiction and tolerance and the belief that reporting pain can distract a physician from focusing on curing one 's disease . Ninety percent of the patients had at least some concern about each of the 8 topics , and mean scores on the 8 subscales were near the midpoint on a 0–5 scale . There were significant inverse relationships between level of education , income , and BQ‐PR total score . Those persons who experienced cancer‐related pain on the day they completed the question naire were categorized as using adequate versus not adequate analgesic medication , a determination that was based on a comparison of their level of pain to the medication they were using . Those who were not using adequate analgesic medication had higher BQ‐PR total scores than did those who were using adequate medication Adherence to analgesics in cancer patients has scarcely been studied . In this study , the Medication Event Monitoring System ( MEMS ) and medication diaries were compared with respect to feasibility and adherence measurements .  Forty-six out patients with nociceptive pain caused by cancer were asked to use MEMS for their analgesics and to record their medication usage in a diary for four weeks . Seventy-nine percent of the patients used MEMS for the full four-week period ; 70 % did so for the diary . The majority of patients were satisfied with both MEMS and diary . Adherence data assessed by MEMS and diary were comparable . Patients used the amount of analgesics adequately ( taking adherence : 87 % ) but took them irregularly ( timing adherence : 53 % ) . Subgroup analyses in patients using single and multiple analgesic regimens confirmed the comparable suitability of both methods . MEMS and a medication diary are equally useful for analgesic adherence measurement in cancer patients with pain Although the effective management of cancer pain depends on adequate collaboration and cooperation of the physician and the nurse , little research has been done comparing the attitudes of the two groups . This study investigated the attitudes of physicians and nurses toward  cancer pain  and its treatment with respect to three domains : ( a ) the management of cancer pain as a health-care issue ; ( b ) the potential problems of addiction and drug misuse ; and ( c ) the involvement of patients in the management of their own pain . A question naire was mailed to a r and omly selected sample of individuals registered with the Health Professions Bureau of Indiana . It was completed by 500 physicians and 471 nurses . Specific differences that were found are discussed , along with the implication s of these differences for the management of cancer pain and the education of professionals PURPOSE / OBJECTIVES To evaluate the effectiveness of a psychoeducational program ( i.e. , PRO-SELF Pain Control Program ) compared to st and ard care in increasing patients '  knowledge regarding  cancer pain management .  DESIGN R and omized clinical trial . SETTING Seven outpatient setting s in northern California . SAMPLE 174 out patients with cancer and pain from bone metastasis . METHODS Following r and omization into either the PRO-SELF or st and ard care group , patients completed the Pain Experience Scale ( PES ) prior to and at the completion of the intervention . MAIN RESEARCH VARIABLES Total and individual item scores on the PES . FINDINGS Total PES knowledge scores increased significantly in the PRO-SELF group ( 21 % ) compared to the st and ard care group ( 0.5 % ) . Significant improvements in knowledge scores for patients in the PRO-SELF group were found on five of the nine PES items when compared to baseline scores . CONCLUSIONS The PRO-SELF Pain Control Program was an effective approach to increase patients '  knowledge of cancer pain management . IMPLICATION S FOR NURSING The use of a structured paper- and -pencil question naire , such as the PES , as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management . Oncology nurses can use patients ' responses to this type of question naire to individualize the teaching and to spend more time on the identified knowledge deficits . This individualized approach to education about pain management may save staff time and improve patient out 
    Output:
    
The most frequently mentioned barriers for both patients and professionals were knowledge deficits , inadequate pain assessment and misconceptions regarding pain .
Studies on professional education and pain assessment did not evaluate patients ' outcomes .