Cancer är av de vanligaste sjukdomarna i västvärlden. Sjukdomen innebär för många smärta och minskad livskvalitet. För att bidra till ökad livskvalitet även hos personer med cancer som inte går att bota, har palliativ vård utvecklats. Denna vård syftar bland annat till att bedöma och utvärdera smärta och utifrån detta erbjuda behandling. Syftet med studien var att kartlägga hur patienter upplever cancersmärta, vilka faktorer som påverkar upplevelsen och hur patienterna upplever sjukvårdens insatser för att lindra smärtan. Ett ytterligare syfte var att undersöka om det fanns skillnader i ovanstående mellan patienter av olika ålder och kön. Studien var deskriptiv och kartlade upplevelser av smärta hos patienter med i huvudsak gastrointestinal cancer. Patienterna beskrev ”just nu” och den ”vanliga” smärtans intensitet, kvalitet, lokalisation och duration samt hur smärtan påverkades av fysisk aktivitet och vila. Patienterna fick också beskriva smärtbehandlingen och dialogen med vårdpersonalen. Instrumentet som användes för att bedöma smärta kallas Pain-O-Meter. Detta ger möjlighet att utvärdera både den sensoriska och affektiva komponenten av smärtan samt dess lokalisation och duration Resultaten visade att även patienter som tas omhand på en specialiserad smärtmottagning upplever smärta. Emellertid beskrev patienterna smärtan under en vanlig dag som mer intensiv än den smärta de upplevde vid mottagningsbesöket. Vi fann också skillnad i smärtupplevelse i vila och under aktivitet. Många patienter som upplevde smärta, hade dåliga kunskaper om smärtans negativa påverkan på livskvaliteten, och om olika möjligheter till smärtbehandling. Studien visar vikten av att sjukvårdspersonalen systematiskt analyserar patienternas smärta, och hur den varierar i olika situationer, för att kunna ge bästa möjliga palliation och smärtlindring, eftersom målet med den palliativa vården är att skapa bästa möjliga hälsorelaterade livskvalitet även för personer med obotlig cancer. / Cancer is one of the most common diseases in the West World. Cancer is also a disease that accounts for much pain and decreases in quality of life in the suffering individuals. The assessment of dimensions of pain is very important for the individual treatment in the palliative care to increase quality of life in patients with cancer. The aim of this study was to describe the incidence and intensity, quality, location and duration of the present or “just now” and the usual or “every-day” cancer pain. An other aim was to describe the differences of factors, even deference of age and gender. Pain experiences were assessed with Pain-O-Meter (POM): The POM combines the qualities of McGill Pain Questionnaire and the Visual Analogue Scale into one tool, and is therefore useful for evaluation of different dimensions of the pain experience. POM also makes it possible to assess the location and duration of the pain. The result showed that all subjects experienced moderate to severe usual pain even though they were patients at a clinic specialized in palliative care for individuals suffering from cancer. The most interesting finding was that the patients in the assessment situation experienced their present pain to be more intensive then the usual or “every day” pain. These finding have implications for how to ask the patients about their pain. The results also indicated that the individuals experienced more intense pain during physical activities compared to the pain during rest. This will increase incidences of complications and decrease quality of life in this group of patients / <p>ISBN 91-7997-120-2</p>

This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain &gt; 3 on VAS and 79 reported VAS &gt; 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain &gt;3 on POM-VAS and 47 patients reported &gt;3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain &gt; 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain &gt; 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.