Jho, H.J., Myung, S.K., Chang, Y.J., Kim, D.H., & Ko, D.H. (2013). Efficacy of pain education in cancer patients: A meta-analysis of randomized controlled trials. Supportive Care in Cancer, 21, 1963–1971.

STUDY PURPOSE: To evaluate the overall efficacy of pain education among patients with cancer by using a meta-analysis of randomized controlled trials (RCTs)

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: PubMed, EMBASE, Cochrane Library

KEYWORDS: cancer; pain; education; counseling

INCLUSION CRITERIA: RCTs that included patients with cancer with pain, used an education intervention for cancer pain management, and presented pain intensity at baseline and after intervention

EXCLUSION CRITERIA: Duplicated studies; same study in more than one publication

TOTAL REFERENCES RETRIEVED = 213 (36 thoroughly reviewed)

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two investigators independently reviewed and then compared discrepancies. Studies were rated on a 1–5 quality scale for RCT evaluation.

• FINAL NUMBER STUDIES INCLUDED = 12
• TOTAL PATIENTS INCLUDED IN REVIEW = 2,169 total patients; 1,069 patients enrolled in an intervention and 1,100 in a control arm
• KEY SAMPLE CHARACTERISTICS: Mean age was 57.2 years; 59% women

• PHASE OF CARE: Multiple phases of care     
• APPLICATIONS: Elder care, palliative care

• Overall pain education for patients with cancer showed a small but insignificant effect (standardized mean difference -0.11).
• Pain education was more effective in inpatients than outpatients.
• Pain education was more effective within two weeks of a first follow-up.
• A difference existed in the efficacy of the pain education based on pain intensity.
• Pain education was effective when tailored to an individualized patient. No beneficial effect was observed in high-quality studies, but lower pain was found in low-quality studies.
• Overall, insufficient evidence exists to support the use of pain education in patients with cancer.

This study showed that overall pain education in patients with cancer showed a small efficacy on pain relief in the meta-analysis of these RCTs.

• Authors note that many studies were not included because of lack of data.
• Predictors of pain response were not evaluated (e.g., age, socioeconomic status, education).
• Attention control inconsistent within the studies
• Quality of life or distress of pain on the patient not examined

Further studies are needed regarding the use of pain education on patients with cancer and the relation to pain relief. Because some patients benefited from the interventions, nurses may focus on situations in which patients received the most benefits (e.g., inpatients, patients with the most severe pain, education within the first two weeks of follow-up).