Effects of training on a simulator of pain care on the quality of pain care for patients with cancer-related pain.

Context: A computer simulator of pain care provided an environment for residents to learn to (1) rapidly induce pain relief; (2) measure pain scores at appropriate time intervals; (3) use induction doses to estimate, early in care, the long-acting pain medication requirements; and (4) escalate long-acting agents to ensure a smooth and nonvarying pain-control curve. We studied whether lessons learned on the simulator translated into improved pain control for patients with cancer-related pain crises.

Study Design And Measures: We compared pain scores for 48 hours in 2 groups: 20 patients admitted consecutively, solely because of an acute exacerbation of pain, prior to training our residents on a simulator and 20 patients post-training. Training at the beginning of an oncology rotation consisted of education about pain control followed by practice on simulated cases of patients with cancer-related pain crises. Outcome measures were average pain scores compared using linear regression and the frequency of using long-acting agents early in a patient's care.

Results: Pain control in the first 48 hours of care improved in the postintervention period; the slope of the pain scores actually increased in the preintervention period and declined in the postintervention period (P < .0005). Residents used long-acting agents early in patients' care in 35% (7/20) in the preperiod and 90% (18/20) in the postperiod (P < .001).

Conclusions: Residents developed pain care treatment skills on a computer-based simulator that translated into improved control of acute, cancer-related pain.