Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service

Abstract

Although pain assessment is a vital preliminary step towards the satisfactory control of cancer pain, data on the prevalence of different pain syndromes are rare. In a prospective study of 2266 cancer patients, we assessed localisations, aetiologies and pathophysiological mechanisms of the pain syndromes. Thirty percent of the patients presented with 1, 39% with 2 and 31% with 3 or more distinct pain syndromes. The majority of patients had pain caused by cancer (85%) or antineoplastic treatment (17%); 9% had pain related to cancer disease and 9% due to aetiologies unrelated to cancer. Pain could be classified as originating from nociceptors in bone (35%), soft tissue (45%) or visceral structures (33%) or otherwise as of an neuropathic origin (34%). In most patients, pain syndromes were located in the lower back (36%), abdominal region (27%), thoracic region (23%), lower limbs (21%), head (17%) and pelvic region (15%). The main pain syndrome was also coded according to the IASP Classification of Chronic Pain. Regions and systems affected by the main pain syndrome showed large variation depending on the site of cancer origin, whereas temporal characteristics, intensity and aetiology were not markedly influenced by the cancer site. The variety of pain syndromes evaluated in our patients confirms the importance of comprehensive pain assessment prior to treatment.

Cancer Pain Prevalence and its Management

“…The prevalence and the severity of pain experienced by cancer patients depend upon several factors such as the stage, the site, and the region of metastasis related to the disease. In this respect, pain in cancer patients can be examined in three major groups, by cancer etiology, by anti-neoplastic treatment, and by cancer disease (Grond et al, 1996, Gong et al, 2013, Demir et al, 2013.…”

Avaliação da S(+) cetamina por via oral associada à morfina no tratamento da dor oncológica

“…Na primeira consulta, 82,5% dos pacientes apresentava dor moderada a intensa pela escala verbal, o que está muito próximo a alguns estudos que referem dor oncológica de igual intensidade em mais de 60% dos casos 21,24 . A maioria dos pacientes incluídos (em torno de 90%) fazia uso prévio de medicação analgésica, o que está de acordo com alguns estudos que encontraram o uso de medicação prévia em mais de 80% dos pacientes atendidos em regime ambulatorial, porém bem superior aos dados de outro autor, que encontrou uso de medicação prévia em apenas 8% dos pacientes 21,25 . Quando a avaliação da dor foi feita pela escala verbal nos retornos subseqüentes, observou-se que houve diminuição das queixas de dor de intensidade moderada a intensa e predomínio de ausência da dor após a introdução da terapêutica.…”

“…After explaining the aims of the study, patients signed and informed consent, and filled out a first consultation form (M 0 ). Each patient was followed up individually by means of 21 , and M 28 , respectively). Patients were not allowed to take any drugs or use any analgesic techniques besides those prescribed by the study protocol.…”

Reagudizaciones en pacientes con dolor crónico

“…Otros pacientes desarrollan dolor crónico a consecuencia de terapias del cáncer como la cirugía o la quimioterapia (8). Las principales localizaciones del dolor crónico oncológico se han referido en la columna lumbar (36%), abdomen (27%), región torácica (23%), extremidades inferiores (21%), cabeza 17% y pelvis (15%) (9).…”