The characteristics of 111 patients included in the study are shown on table 1
. Also, further interviews were done with 15 patients in this group who were illiterate. The results of these questionnaire are depicted on table 2
Table 1: The characteristics of patients
Table 2: Results of questionnaire
Thirteen patients (11,8%) indicated that they could not inform the doctor about pain clearly because of either short interview or their shyness. Twenty-three patients (19,8%) thought the doctor might not understand them adequately. They thought that the main causes of physicians misunderstanding about pain were short interview and less communication with physician (Table 3). Although 48 patients (43,3%) didnt know the cause of the pain, others (56,7%) were aware that it was related to cancer.
Table 3: The causes of physicians misunderstanding of pain according to patients
Eighty patients (72.1%) have been taking analgesics irregularly. Twenty (32,7%) of 61 patients who didnt have improvement of the pain completely, have lost their hope on relief of pain. Only 13 (21,3%) of these patients have been taking analgesics regularly.
Thirty-one (27,9%) of the patients said analgesics had some side effects on gastrointestinal system and sleeping. Interestingly, 28 of 31 patients (90,3%) who had side effects of analgesic have been taking them regularly.
While 40 patients (36%) believed that the analgesic addiction would occur, other 40 patients (36%) didnt believe it would and the rest of them (28%) had no any idea about it.
Twenty-nine patients (26.1%) used narcotic analgesics and pain was not controlled completely in 13 of them (44,8%). Fourteen of these 29 patients (48,2%) didnt know whether their medicine was narcotic or not. Also pain was not controlled completely in 37 of 68 patients (54,4%) who didnt take narcotic analgesics.
There was a significant positive correlation between using narcotic analgesics and regular use of them (p=0.024). Also, we observed a significant positive correlation between the patients confidence of improvement and communication with the physician (p=0.03).
Although 12 patients (10,8%) refused taking narcotic analgesics in future, others accepted it, after they were convinced by their doctor that it was necessary (Table 2). The rejection rate of narcotic analgesics in future was significantly higher in patients who had completely relieved pain at the present time than unrelieved group (49% vs. 91.6%, respectively) (p=0.001). Also, another significant finding was that rate of narcotic consent was higher in unrelieved pain group (p=0,001). The rate of belief on developing analgesic addiction was higher in patients taking narcotics than others (51.7% vs. 30.8%, p=0.04). Multivariate regression analyses showed that there was a significant relation between regularly taking analgesic and control of pain (p=0.026).
During individual interviews with 15 patients who were illiterate, we observed wrong perceptions about pain in patients with advanced cancer such as, pain is fatalistic and the analgesic addiction will occur in future which will lead to more suffering. Most of the patients were not taking analgesics, because of such fears and wrong beliefs.