A pilot study to improve pain phenotyping in head and neck cancer patients

Abstract

Pain associated with head and neck cancer (HNC) is difficult to manage and reduces quality of life. It has been increasingly recognized that HNC patients exhibit a wide range of pain symptoms. Here we developed an orofacial pain assessment questionnaire and conducted a pilot study to improve pain phenotyping in HNC patients at the diagnosis. The questionnaire captures the following pain characteristics: pain intensity, location, quality, duration, and frequency; the impact of pain on daily activities; changes in smell and food sensitivities. Twenty-five HNC patients completed the questionnaire. 88% patients reported pain at the site of tumor; 36% reported multiple pain sites. All patients with pain reported at least one neuropathic pain (NP) descriptor, 54.5% reported at least two NP descriptors. The most common descriptors were “burning” and “pins and needles”. Most patients reported increased pain to sour or hot/spicy food/drinks, and to food with coarse/hard textures. Patients exhibited impaired oral function, especially chewing, talking, mouth/jaw opening, and eating. Tumor progression has a significant impact on pain. Nodal metastasis is linked to pain at multiple body sites. Patients with advanced tumor staging experience greater pain at the primary tumor site, when exposed to hot or spicy food/drinks or food with hard/coarse texture, or when eating or chewing. We conclude that HNC patients experience a wide range of pain symptoms with altered mechanical, chemical, and temperature sensation. Improved phenotyping and stratification of pain in HNC patients will help address the underlying etiology, which may enable personalized therapeutic approaches in the future.

Effect of nutrition impact symptoms on oral nutritional supplements energy intake and use days in patients with head and neck cancer: A cross‐sectional study

“… 51 , 52 A pilot study in Brazil found that HNC patients experience a wide range of pain symptoms with altered mechanical, chemical, and temperature sensation. 50 This may be a reason for decreased dietary and ONS intake of HNC patients with pain.…”

“…In the study, patients with pain were less likely to have ONS energy intake ≥400 kcal/day than those without the symptom. Pain affects more than 70% of HNC survivors 50 . Chronic pain resulted from cancer or cancer treatments such as surgery, radiation, and chemotherapies or in combination, is particularly challenging as patients suffer from multiple oral complications such as orofacial pain, changes in taste, and oral dysfunction 51,52 .…”

“…Chronic pain resulted from cancer or cancer treatments such as surgery, radiation, and chemotherapies or in combination, is particularly challenging as patients suffer from multiple oral complications such as orofacial pain, changes in taste, and oral dysfunction 51,52 . A pilot study in Brazil found that HNC patients experience a wide range of pain symptoms with altered mechanical, chemical, and temperature sensation 50 . This may be a reason for decreased dietary and ONS intake of HNC patients with pain.…”

Targeting TRPV1 for Cancer Pain Relief: Can It Work?

“…Cancer pain usually affects several dermatomes. Of note, oral cancer patients often experience severe pain at the site of cancer with new sensitivity to spicy food [ 123 ]. These patients are very sensitive to local capsaicin challenge [ 124 ], indicating increased TRPV1 expression and/or sensitization.…”