The study of clinical states in cancer patients is of fundamental importance for medical sciences. For example, it is well established empirically that one of the central manifestations of cancer development is pain. Research data show that more than half of cancer patients report pain (Dalal & Bruera, 2019; Durham, Strassels, & Pinsky, 2021; Scarborough & Smith, 2018). In fact, current advances in medical science have reached the point where the life expectancy of cancer patients is rapidly increasing (Jiang et al., 2019). For example, citing a 40-year study, Scarborough and Smith (2018) reported that 64% of patients with metastatic cancer typically report pain, and another 59% of those currently undergoing anti-cancer treatment also report pain. In addition, one-third of patients report pain even after completing treatment. As a consequence, practical pain assessment and treatment is essential for cancer therapy to improve the health status of cancer patients. Available research evidence supports that pain management significantly improves the vital signs of cancer patients (Charoenpol et al., 2019; Dalal & Bruera, 2019; Durham et al., 2021; Fan et al., 2017). In contrast, inadequate pain control is associated with decreased social life and low social support.
There are different pain management strategies for cancer patients. First and foremost, the primary method of pain management for cancer is the use of opioids (Dalal & Bruera, 2019; Durham et al., 2021). For many years, the choice of this method has been based on personal choice, but recent evidence suggests a number of emerging problems. One major problem is opioid dependence (Durham et al., 2021; Dalal & Bruera, 2019). Furthermore, according to Dalal and Bruera (2019), recent evidence shows that cancer patients are also at risk for non-medical opioid use due to emerging addiction. Due to the increase in opioid-related deaths, the Centers for Disease Control and Prevention (CDC) issued new guidelines to limit opioid use, which also led to limited access for cancer patients (CDC, 2021). In addition, one-third of patients who continue to take pain medication still report pain, raising questions about the effectiveness of opioids when used alone for pain management. These problems and the critical role that effective pain management plays in improving the life outcome of the cancer patient require the development of new pain management strategies.
One new strategy is to keep a pain journal or diary. First and foremost, pain diaries are a self-assessment tool in which a person records his or her pain sensations and their management (Smith, 2021). Physically, it is a paper journal — or notebook — or a virtual platform in which the patient does reflective work in order to describe their pain sensations during therapy. Moreover, the pain diary assists in pain management by helping patients identify the nature of pain, where it is localized, and the impact of different management strategies to determine the most appropriate strategy for managing a particular pain (Smith, 2021). As a result, the completed pain diary represents the dynamics of pain development or inhibition during the entire treatment , including the postoperative recovery phase. Consequently, an experienced clinician can use these records to assess the subjective experience of the patient and, when scaled up, the entire patient sample to evaluate the effectiveness of clinical programs and improve the quality of care provided.
Since the pain diary is a relatively new method of assessment, the study of this phenomenon has well-deserved popularity among the academic medical community. In fact, journaling is a fantastic combination of pedagogical reflection and self-management methods, therefore, it is inappropriate to consider the use of these strategies as an option for medical treatment. Nevertheless, this does not mean that there are no tangible results from the practices undertaken. More specifically, Rosti (2017) has shown that the use of self-management techniques and the context of effective patient-doctor communication is the best narrative medicine strategy. To put it another way, such solutions allow one to critically evaluate what the patient is experiencing during therapy and then use that to adjust the individualized plan. In cancer pain, a study by Fan et al. (2017) showed that pain-based self-management improves patient pain and improves medication compliance in cancer patients. At the same time, ElMokhallalati et al. (2018) proved that pain intensity tends to decrease when the patient engages in self-management of his/her condition and clearly understands the essence of the actions performed. This has also been confirmed by Howell et al. (2017), who proved that such strategies not only improve clinical progress but also reduce the number of medical services required and thus significantly offload the busy clinical agenda of oncology facilities. Consequently, this together can show the high reliability of reflective practices.
Contextual studies of the effectiveness of using pain diaries — or pain notes — are as critical as studies of self-management systems. For example, Erol et al. (2018) were able to show the critical need for nursing support for the patient to become familiar with the possibility of fixing their pain. In other words, the patient can hardly come to fill out a pain journal on his or her own, so it is critical to provide a little training for this. The issue of training has also been raised in a study by Koh et al. (2018), which demonstrated that familiarizing the patient with the pain logging system — in other words, the ability to log pain at different stages of therapy — was influential in reducing overall pain and reducing recovery time. Moreover, in their study, Charoenpol et al. (2019) studied the effect of pain diary on intensity, interference, and intrapersonal changes in patients with general pain: the results showed a decrease in pain intensity at four weeks. This significantly improves the quality of cancer pain management. However, there are very few studies on cancer pain management using pain diaries, which means that this area is understudied. The studies reviewed have shown promising results, and there is a need for more experimental research in this area.
The practice of journaling as applied to pain management in patients with cancer is subject to further examination. However, it should be performed concerning the already known solutions related to self-reporting. As follows from the recent study, the adoption of technology for this purpose seems feasible as it allows the affected persons to increase their confidence levels in the suggested treatment (Oldenmenger et al., 2018). The use of an eConsult also showed that Internet monitoring of pain could be complicated by specific issues, including cognitive problems, withdrawal of participation, Internet problems, and poor condition (Oldenmenger et al., 2018). Therefore, the corresponding risks should be eliminated by carefully planning the proposed interventions of this nature to make them reliable.
These findings lead to the conclusion that the only possible way to introduce pain journals for cancer pain management efficiently is the application of an individualized approach. It is invaluable for determining one’s ability to benefit from them and adequately addresses the task of defining the factors, which positively correlate with the patients’ ability to use such tools consistently. Moreover, the considerations of side effects, the use of analgetics, and self-management can be examined with the help of online journals (Oldenmenger et al., 2018). They can serve as the basis for the provision of future care for medical specialists, who will get timely access to the required information and readjust treatment for a positive outcome.
In conclusion, the necessity to develop alternative methods of managing pain in patients with cancer is conditional upon the dubious efficiency and dependence on opioids. Meanwhile, the development of diaries for this purpose seems a better alternative in the long run, but it should be studied by specialists. These tools have already drawn the medical community’s attention, but at present, the research is limited to generalized statements of their effectiveness and the benefits for medication compliance. It is clear that they increase patients’ confidence, but the development of these solutions should be performed with regard to the technological aspect of the matter.
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Charoenpol, F., Tontisirin, N., Leerapan, B., Seangrung, R., & Finlayson, R. (2019). Pain experiences and intrapersonal change among patients with chronic non-cancer pain after using a pain diary: a mixed-methods study. Journal of Pain Research, 12, 477-487.
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