Incidence and Management of Noncancer Pain in Cancer Patients Referred to a Radiotherapy Center

Massaccesi, Mariangela; Deodato, Francesco; Caravatta, L.; Macchia, G.; Padula, Gilbert D. A.; Rito, Sonia Di; Woldemariam, Aynalem Abraha; Rossi, Marco; Falco, Carlo Di; Tambaro, Rosa; Mignogna, S.; Flocco, Mariano; Pacelli, Fabio; Valentini, Vincenzo; Cellini, Numa; Morganti, Alessio Giuseppe

doi:10.1097/ajp.0b013e31827eb5e6

Cited by 9 publications

(16 citation statements)

References 19 publications

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“…Table 1 shows the selected characteristics of the 66 studies from 1994 to 2020 1,4–23,25–67 . Considering the whole period, the weighted mean of negative PMI decreased from 47% to 40%.…”

Section: Resultsmentioning

confidence: 99%

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Living systematic review to assess the analgesic undertreatment in cancer patients

et al. 2022

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Background and aims This living and systematic review aimed to provide an updated summary of the available evidence on pain undertreatment prevalence in patients with cancer; correlations with some potential determinants and confounders were also carried out. Materials and methods We updated a systematic review published on 2014, including observational and experimental studies reporting the use of the pain management index (PMI) in adults with cancer and pain, from 2014 to 2020. We conducted searches in PubMed/MEDLINE, Embase, and Google Scholar. We performed univariate and multivariable regression analyses to describe the relationship between PMI and a list of potential explanatory variables. Results Twenty new papers were identified, yielding a total sample size of 66 studies. The proportion of patients classified as undertreated according to the year of study publication shows a higher decrease from 1994 to 2013 (−13% as relative change) than the most recent years 2014–2020 (−11%). The quality of the included studies has increased over the years (from 80% to 93%). At the multivariable analysis, a statistically significant relationship was confirmed between undertreatment and the year of the publication of the study and with a low–medium economic level of the countries, where the studies were conducted. Discussion Despite the improvement when compared to the period 1994–2000, still about 40% of the cases identified received an analgesic treatment inadequate to the intensity of pain, according to the PMI. Despite its intrinsic limitations, PMI continues to be widely used, and it could allow a continuous monitoring of pain management across a different mix of studies and patients.

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Section: Resultsmentioning

confidence: 99%

“…The full text of the remaining 41 hits was examined; and 19 were excluded as not regarding cancer pain and two were excluded because they were qualitative studies. The 20 studies 4–23 that met the inclusion criteria and were included in the current analysis are listed in Table . The flowchart of study selection is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Living systematic review to assess the analgesic undertreatment in cancer patients

et al. 2022

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“…Patients with cancer often present with an underappreciated noncancer pain component. In a study of 903 patients with cancer at a radiotherapy center, the incidence of noncancer pain was higher than the incidence of cancer pain and contributed significantly to the patient's overall pain burden . In this study of patients suffering from both cancer and noncancer pain components, it was more likely that the noncancer pain be uncontrolled than the cancer pain ( P < 0.001).…”

Section: Types Of Cancer Painmentioning

confidence: 75%

Treatment Considerations for Cancer Pain: A Global Perspective

Pergolizzi

Gharibo

2014

Pain Practice

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Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. Reasons for undertreating cancer pain include attitudes of patients, clinicians, and factors associated with healthcare systems. The consequences of not treating cancer pain may include reduced quality of life for patients with cancer (who now live longer than ever), functional decline, and increased psychological stress. Early analgesic intervention for cancer pain may reduce the risk of central sensitization and chronification of pain. To manage pain in oncology patients, clinicians should assess pain during regular follow-up visits using validated pain measurement tools and follow prescribing guidelines, if necessary referring patients with cancer to pain specialists. Many patients with cancer require opioids for pain relief. Pain associated with cancer may also relate to cancer treatments, such as chemotherapy-induced peripheral neuropathy. Many patients with cancer are what might be considered "special populations," in that they may be elderly, frail, comorbid, or have end-stage organ failure. Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes.

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“…One-third of cancer patients presented with chronic non-malignant pain at consultation. A handful of studies have reported the prevalence of chronic non-malignant pain in cancer patients, which varied between 2% and 76% [13,14]. This wide variation may be explained by differences in the patient population, definitions, and study methodology.…”

Section: Discussionmentioning

confidence: 99%

“…This wide variation may be explained by differences in the patient population, definitions, and study methodology. Specifically, previous studies were mostly retrospective in nature [14][15][16] and non-malignant pain diagnosis was not the main study outcome [13,17]. Moreover, a majority of studies focused on documenting one main pain site per patient when patients often presented with multiple pain types, which could result in an underestimation.…”

Section: Discussionmentioning

confidence: 99%

Chronic Non-Malignant Pain in Patients with Cancer Seen at a Timely Outpatient Palliative Care Clinic

Hui

Abdelghani

Chen

et al. 2020

Cancers

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Palliative care is seeing cancer patients earlier in the disease trajectory with a multitude of chronic issues. Chronic non-malignant pain (CNMP) in cancer patients is under-studied. In this prospective study, we examined the prevalence and management of CNMP in cancer patients seen at our supportive care clinic for consultation. We systematically characterized each pain type with the Brief Pain Inventory (BPI) and documented current treatments. The attending physician made the pain diagnoses according to the International Association for the Study of Pain (IASP) task force classification. Among 200 patients (mean age 60 years, 69% metastatic disease, 1-year survival of 77%), the median number of pain diagnosis was 2 (IQR 1–2); 67 (34%, 95% CI 28–41%) had a diagnosis of CNMP; 133 (67%) had cancer-related pain; and 52 (26%) had treatment-related pain. In total, 12/31 (39%) patients with only CNMP and 21/36 (58%) patients with CNMP and other pain diagnoses were on opioids. There was a total of 94 CNMP diagnoses among 67 patients, including 37 (39%) osteoarthritis and 20 (21%) lower back pain; 30 (32%) were treated with opioids. In summary, CNMP was common in the timely palliative care setting and many patients were on opioids. Our findings highlight the need to develop clinical guidelines for CNMP in cancer patients to standardize its management.

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Incidence and Management of Noncancer Pain in Cancer Patients Referred to a Radiotherapy Center

Abstract: In a cancer patients' population referred to a radiotherapy center, the NCP incidence was higher than the CP incidence and NCP intensity was only slightly lower than CP. NCP was significantly pharmacologically undertreated and it was related to a decline in QoL.

Cited by 9 publications

References 19 publications

Living systematic review to assess the analgesic undertreatment in cancer patients

Living systematic review to assess the analgesic undertreatment in cancer patients

Treatment Considerations for Cancer Pain: A Global Perspective

Chronic Non-Malignant Pain in Patients with Cancer Seen at a Timely Outpatient Palliative Care Clinic

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