Context. In a previous retrospective study, cancer pain management was effective in 47.5% of a cohort assessed after 3 months in a pain clinic at Siriraj Hospital. New guidelines were established, including a multidisciplinary approach, availability of pain interventions, and palliative care referral. Objectives. The objective was to examine the effectiveness of the updated approach. Methods. With IRB approval, outpatients with cancer were enrolled from January to December 2018. Assessments were recorded at baseline and three consecutive visits (BL, FU1, FU2, and FU3), including Numerical Rating Scale (NRS), the Brief Pain Inventory (BPI), the Edmonton Symptom Assessment System (ESAS), side effects, and analgesic use. The primary outcome was a favorable response, defined as an NRS decrease more than 30% or NRS <4. Secondary outcomes included trends over time in BPI, ESAS, side effects, and analgesic use. Pain response predictors at FU3 were analyzed using logistic regression. Results. Among 150 patients, 72 (48%) completed follow-ups. Of these, 61% achieved a favorable response at FU3. Pain interference diminished at all visits relative to baseline (). Median morphine equivalent daily dosage (MEDD) at BL was 20 mg/day, with a statistically significant, but clinically modest increase to 26.4 mg/day at FU3. Radiation therapy during pain care was a predictor of pain responders. Conclusion. The current Siriraj multidisciplinary approach provided effective relief of pain and stabilization of other cancer-related symptoms. Radiation therapy during pain care can be used to predict pain outcomes. Ongoing improvement domains were identified and considered in the context of cultural, economic, and geographic factors.

中文翻译：

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泰国三级医院疼痛门诊癌症疼痛管理的有效性：一项前瞻性观察研究

上下文。在之前的一项回顾性研究中，在 Siriraj 医院的疼痛诊所接受 3 个月评估后，47.5% 的队列中癌症疼痛管理有效。制定了新的指南，包括多学科方法、疼痛干预的可用性和姑息治疗转诊。目标。目的是检查更新方法的有效性。方法. 经 IRB 批准，2018 年 1 月至 12 月招募了癌症门诊患者。 在基线和连续 3 次就诊（BL、FU1、FU2 和 FU3）时记录评估，包括数值评定量表 (NRS)、简要疼痛量表 (BPI) 、埃德蒙顿症状评估系统 (ESAS)、副作用和镇痛剂使用。主要结果是良好的反应，定义为 NRS 下降超过 30% 或 NRS <4。次要结果包括 BPI、ESAS、副作用和镇痛剂使用随时间的趋势。使用逻辑回归分析 FU3 的疼痛反应预测因子。结果。在 150 名患者中，72 名 (48%) 完成了随访。其中，61% 在 FU3 中取得了良好的反应。相对于基线，所有访问的疼痛干扰都减少了（）。BL 时的中位吗啡等效日剂量 (MEDD) 为 20 毫克/天，具有统计学意义，但临床上适度增加至 FU3 时的 26.4 毫克/天。疼痛护理期间的放射治疗是疼痛反应者的预测指标。结论。目前的 Siriraj 多学科方法可有效缓解疼痛并稳定其他癌症相关症状。疼痛护理期间的放射治疗可用于预测疼痛结果。在文化、经济和地理因素的背景下，确定并考虑了正在进行的改进领域。