Effectiveness of Education Interventions for the Management of Cancer Pain: A Systematic Review

  • Lee, Yoon Jae (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University) ;
  • Hyun, Min Kyung (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University) ;
  • Jung, Yea Ji (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University) ;
  • Kang, Min Joo (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University) ;
  • Keam, Bhumsuk (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University) ;
  • Go, Su Jin (National Evidence-based Healthcare Collaborating Agency, Seoul National University Hospital, Seoul National University)
  • Published : 2014.06.30


Background: Many cancer patients experience poor pain control due to various factors, including misconceptions regarding the use of opioid analgesics. For management of cancer pain, interventions involving education of both patients and physicians have been attempted. Objectives: This review aimed to assess the current evidence of the benefits of education for the management of cancer pain. Methods: We searched the Medline, EMBASE, Cochrane library, and major Korean databases to identify relevant studies. We included most study designs, but excluded case series. The primary outcomes were pain intensity and quality of life (QoL). Two reviewers assessed the risk of bias using the Cochrane's tool for RCT and Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) for non-randomized studies, independently. Results: After extensive searches, 3,324 publications were screened, and 32 studies were selected. The education interventions used in the included studies included a wide variety of education methods, but the most common method was a booklet produced for patients. Regardless of the education method used, the results of the meta-analysis were as follows. The SMDs of the most severe, average, and current pain in the RCTs were significant. The SMD of worst, average, and current pain were -0.34 (-0.55, -0.13), -0.40 (-0.64, -0.15), and -0.79 (-1.35, -0.23). In the non-randomized studies, the effects on average pain were significant, but those on worst and current pain were not. Conclusions: Education intervention reduced the pain of cancer patients. Therefore, patient education could be considered to be an effective method of cancer pain management. However, our data should be interpreted with caution, and studies using standardized protocols are needed to confirm these observations.


Supported by : National Evidence-based Healthcare Collaborating Agency (NECA)


  1. Ward SE, Wang KK, Serlin RC, Peterson SL, Murray ME (2009). A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain. Pain, 144, 49-56.
  2. Vallieres I, Aubin M, Blondeau L, Simard S, Giguere A (2006). Effectiveness of a clinical intervention in improving pain control in outpatients with cancer treated by radiation therapy. Int J Radiat Oncol Biol Phys, 66, 234-7.
  3. van der Peet EH, van den Beuken-van Everdingen MH, Patijn J, et al (2009). Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Support Care Cancer, 17, 1089-99.
  4. Ward S, Donovan HS, Owen B, Grosen E, Serlin R (2000). An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Res Nurs Health, 23, 393-405.<393::AID-NUR6>3.0.CO;2-O
  5. World Health Organization. (1996). Cancer pain relief: with a guide to opioid availability. World Health Organization.
  6. Yang Q, Xie DR, Jiang ZM, et al (2010). Efficacy and adverse effects of transdermal fentanyl and sustained-release oral morphine in treating moderate-severe cancer pain in Chinese population: a systematic review and meta-analysis. J Exp Clin Cancer Res, 29, 67.
  7. Yildirim YK, Cicek F, Uyar M (2009). Effects of pain education program on pain intensity, pain treatment satisfaction, and barriers in Turkish cancer patients. Pain Manag Nurs, 10, 220-8.
  8. Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA (1995). Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain, 63, 65-76.
  9. Miaskowski C, Dodd M, West C, et al (2004). Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management. J Clin Oncol, 22, 1713-20.
  10. Lai YH, Guo SL, Keefe FJ, et al (2004). Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Supportive Care Cancer, 12, 645-52.
  11. Liang SY, Chen KP, Tsay SL, et al (2013). Relationship between belief about analgesics, analgesic adherence and pain experience in taiwanese cancer outpatients. Asian Pac J Cancer Prev, 14, 713-6.
  12. Lovell MR, Forder PM, Stockler MR, et al (2010). A randomized controlled trial of a standardized educational intervention for patients with cancer pain. J Pain Symptom Manage, 40, 49-59.
  13. Nevidjon B (2010). Using leadership and advocacy to improve cancer pain management--based on a presentation at the cancer pain, suffering and spirituality course. Asian Pac J Cancer Prev, 11, 13-6.
  14. Quigley C (2008). Opioids in people with cancer-related pain. Clin Evid (Online), 2008, 2408.
  15. Shin SB, Lee MH (2003). The effect of cancer pain management education on the pain and the concerns of pain management in cancer patients. Korean J Rehabil Nurs, 6, 90-103.
  16. Syrjala KL, Abrams JR, Polissar NL, et al (2008). Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial. Pain, 135, 175-86.
  17. Thomas ML, Elliott JE, Rao SM, et al (2012). A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum, 39, 39-49.
  18. de Wit R, van Dam F (2001). From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain. J Adv Nurs, 36, 742-54.
  19. Bennett MI, Bagnall AM, Jose Closs S (2009). How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain, 143, 192-9.
  20. Brant JM (2010). The global experience of cancer pain. Asian Pac J Cancer Prev, 11, 7-12.
  21. Chang MC, Chang YC, Chiou JF, Tsou TS, Lin CC (2002). Overcoming patient-related barriers to cancer pain management for home care patients: a pilot study. Cancer Nurs, 25, 470-6.
  22. de Wit R, van Dam F, Zandbelt L, et al (1997). A pain education program for chronic cancer pain patients: follow-up results from a randomized controlled trial. Pain, 73, 55-69.
  23. Hong SH, Roh SY, Kim SY, et al (2011). Change in cancer pain management in Korea between 2001 and 2006: results of two nationwide surveys. J Pain Symptom Manage, 41, 93-103.
  24. Keefe FJ, Ahles TA, Sutton L, et al (2005). Partner-guided cancer pain management at the end of life: a preliminary study. J Pain Symptom Manage, 29, 263-72.
  25. Kim SY, Park JE, Lee YJ, et al (2011). NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul: National Evidence-based Healthcare Collaborating Agency.
  26. Kim SY, Park JE, Lee YJ, et al (2013). Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol, 66, 408-14.
  27. Kwon IG, Whang MS, Kim JH (2002). Effects of pain management education on pain of the terminal cancer patients at home. J Korean Oncol Nurs, 2, 36-49.
  28. Allard P, Maunsell E, Labbe J, Dorval M (2001). Educational interventions to improve cancer pain control: a systematic review. J Palliative Med, 4, 191-203.
  29. Aubin M, Vezina L, Parent R, et al (2006). Impact of an educational program on pain management in patients with cancer living at home. Oncol Nurs Forum, 33, 1183-8.

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