Which of the following is NOT consistent with signs of ineffective pain management?

Declining cancer treatment is not necessarily a sign of ineffective pain management. Patients might refuse treatment for various reasons, such as personal beliefs, the perceived quality of life, or concerns about side effects. This decision can stem from factors unrelated to the management of pain itself.

In contrast, a reported pain level of 9/10 indicates severe pain, which clearly reflects ineffective management since patients should ideally experience a lower level of discomfort with appropriate interventions. Similarly, the inability to sleep can be a direct consequence of unmanaged pain, as severe or chronic pain often disrupts normal sleep patterns. An increased heart rate is another physiological response that can occur due to untreated pain, indicating that the body is under stress. Therefore, options A, C, and D all represent clear signs of ineffective pain management, while declining cancer treatment does not directly correlate with the effectiveness of pain control.