Evaluating treatment modalities in chronic pain treatment by the multi-criteria decision making procedure

Abstract

Background: Chronic pain is one of the most common complaints of cancer patients. There are many pharmacological and non-pharmacological treatment modalities used for the treatment of pain. Nonetheless, non-pharmacological interventions are preferred because of potential side effects in cases resistant to medical therapy that require a dose increase or potent drug use. In most real-life situations, the decision on which technique to choose is based on the clinical but subjective decisions of the practitioners. This study aimed to find out the best non-pharmacological treatment option for patients with chronic cancer pain by following a rational and reasonable approach. Methods: Since the evaluation of treatment options requires to make a comparison between a number of alternatives in the light of certain criteria, we utilize the order relation analysis (G1-method) which is a method for determining the weights based on the improved Analytic Hierarchy Process (AHP). The method uses the relative importances on prioritizing the four criteria and eight sub-criteria defined by the experts of three pain physicians, one oncologist, and one oncologic surgeon. Four alternatives are then compared according to the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) using the verbal subjective judgments of the practitioners. Results:Obtained results indicate that the general medical condition of the patient and the stage of the cancer are the essential factors in the selection of the treatment method. It is followed by the extent of the pain and the level of evidence, respectively. According to the evaluations performed, spinal port and splanchnic nerve radiofrequency thermocoagulation treatments are the first and second priority methods for pain treatment, respectively, compared to lumbar epidural catheter and celiac plexus block. Conclusions: The results of this study emphasize the need to integrate critical criteria into the decision-making process objectively. This is the first study in which multi-criteria decision-making tools are used in the evaluation and selection of pain management methods in cancer patients.

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Determination of monosaccharides in Lycium barbarum fruit polysaccharide by an efficient UHPLC‐QTRAP‐MS/MS method

“…The relative closeness to the ideal object ( C i ) was calculated and alternatives were ranked by comparing C i values. The evaluation object is closer to the best level when C i is closer to 1; the evaluation object is closer to the worst level when C i is closer to 0: 24–26 …”

Impact of cryoablation on operative outcomes in thoracotomy patients

“…However, this method of intraoperative exposure requires significant rib retraction and possible rib resection, which can result in increased postoperative pain secondary to damage to intercostal nerves [ 2 ]. Thoracotomy incisions have been associated with higher rates of narcotic use compared to other surgical incisions [ 3 ], and there are multiple efforts being undertaken to reduce postoperative narcotic use [ 4 , 5 ]. Furthermore, post-thoracotomy pain syndrome can result in chronic pain issues for many patients and increase the risk of prolonged use of narcotic pain medications [ 6 , 7 ].…”