Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy

Abstract

Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.

Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer

“…The patients in Paper III experienced low pain intensity and low pain interference during early RT, which is in line with earlier studies [35,186]. The importance of being pain-free was demonstrated in one study of patients with newly diagnosed HNC who were asked to rank their treatment priories.…”

“…The low pain assessment ratings may have contributed to the lack of significant differences between the groups, since it may be easier to reduce strong pain than to reduce pain, which is already at low intensity [220]. An earlier study also reported mild pain among patients with HNC [186], though in other studies, patients with HNC have reported moderate to severe pain during RT [33,134,221]. Another possible contributing reason for the relatively low pain intensity may be that the patients systematically monitored their pain (particularly via text message three times a week), which may have given them a certain sense of control.…”

Interventional Techniques for Head and Neck Cancer Pain

“…Sometimes, it occurs due to medical or surgical treatment. Some studies report cancer-related pain in 52% of the hospitalized patients, of which 50% was due to surgery and 29% directly related to the tumor [7].…”

“…Combined chemotherapy and radiation therapy results in increased frequency, severity and duration of mucositis. The treatment given to patients with HNC represents an important impact on the development of pain and the magnitude of it [7,2].…”

“…In long term, chronic hypoxia leads to ibrosis in perineural tissues and causes late onset neuropathic pain, even in cancer-free survivors [7,2].…”