Twenty-three studies were identified. The majority of studies used the visual analogue scale (VAS) for pain measurement and the Medical Outcomes Study Short-Form 36 (SF-36) for the measurement of HRQL. A reasonably consistent picture emerged from the literature, with the HRQL domains most often affected by pain (social functioning/mental health). Estimates of the prevalence of chronic pain and discomfort following IHR vary widely between studies. This is probably a reflection of the range of methods used for measuring pain, many of which do not have established psychometric properties. Our review suggests that a proportion of patients experience chronic pain and discomfort, which has a significant impact on HRQL. However, the current instruments used in the evaluation of chronic pain after IHR are not comparable and standardisation is required.

Although this study was limited by the relatively small sample size, it is a part of an extensive validation program. This study suggests that the BFI is a reliable and valid measure of constipation-related symptomatology in chronic pain patients. This measure may be a valuable indicator of patients' experience of symptoms of opioid treatment of chronic pain in future trials.

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The health state utility scores from both groups show a decrement in line with worsening anemia. Furthermore, patients who have experienced cancer-related fatigue rate the more severe levels of anemia much lower than the general public.

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