Does pain intensity predict a poor opioid response in cancer patients?

Mercadante, Sebastiano; Gebbia, Vittorio; David, Fabrizio; Aielli, Federica; Verna, Lucilla; Porzio, Giampiero; Ferrera, Patrizia; Casuccio, Alessandra; Ficorella, Corrado

doi:10.1016/j.ejca.2010.12.020

Cited by 16 publications

(17 citation statements)

References 17 publications

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“…However, it has been reported that higher initial pain intensity merely reflects undertreatment of pain. 21,22 We have already reported undertreatment in the present study population, 10 and although 24.1% of this study cohort were PMI negative, this did not predict time to SPC. Moreover, the comparative changes in opioid use, opioid switching, and other therapeutic interventions between baseline and time of SPC, regardless of PMI status, suggest that resources were optimally applied in pursuit of SPC.…”

Section: Discussionmentioning

confidence: 44%

“…19,20 However, there are conflicting reports regarding some classification features, particularly initial pain intensity in predicting time to reach SPC. 21,22 Furthermore, the operational definitions for various classification features of CP such as psychological distress and incident pain have presented interpretive challenges. 19,23 Consequently, further evaluation and clarification of the role of previously identified classification features of CP is necessary.…”

Section: Introductionmentioning

confidence: 99%

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Cancer-Related Pain: A Longitudinal Study of Time to Stable Pain Control and Its Clinicodemographic Predictors

Reis-Pina

Sabri

Birkett

et al. 2019

Journal of Pain and Symptom Management

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Context. Multidimensional assessment is pivotal in managing cancer-related pain. Objectives. The objectives of this study were to determine time to stable pain control (SPC) and identify its baseline clinicodemographic predictors in patients with cancer pain. Methods. This is a prospective longitudinal study of patients attending a cancer pain clinic. Scheduled clinic attendances and weekly investigator-led phone calls enabled monitoring of patients' daily pain diary, opioid use, and other analgesic interventions. Baseline clinicodemographic variables were examined in survival analyses, which included the construction of accelerated failure time models with time ratios [TRs, (95% CIs)], based on time to SPC (pain intensity #3 and <3 breakthrough opioid doses over three consecutive days) for variable categories. Results. Of 319 participants, 22 died before achieving SPC and were censored in the survival analysis. The median survival time (95% CI) to SPC was 22 (19e25) days. In multivariable analysis, compared to their respective reference categories, female sex (P ¼ 0.001), substance abuse (P < 0.001), a neuropathic pain component (P < 0.001), and use of $1 adjuvant analgesic (P ¼ 0.022) each had TRs > 1 (1.03e2.54), whereas soft tissue pain (P < 0.001) had a TR ¼ 0.71 (0.62e0.82), reflecting longer and shorter time to SPC, respectively. Conclusion. SPC is achievable for most patients with cancer pain. Recognition of strong predictors of time to SPC, such as substance abuse, a neuropathic pain component, soft tissue pain, and current use of adjuvant analgesia, may help to triage care services based on therapeutic need and guide analgesic interventions.

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Cancer-Related Pain: A Longitudinal Study of Time to Stable Pain Control and Its Clinicodemographic Predictors

Reis-Pina

Sabri

Birkett

et al. 2019

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

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“…Rapid opioid dose escalation in chronic pain patients could lead to the development of tolerance, although clinical assessment of opioid tolerance remains a challenge [21]. Some investigators have suggested that patients at higher risk may experience more subjective pain, making it even more difficult to adequately assess the clinical effectiveness of opioid therapy [15].…”

Section: Discussionmentioning

confidence: 99%

Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

Chen

Seefeld

et al. 2013

The Journal of Pain

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Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital (MGH) Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score, 2) gender and age differences in response to opioid therapy, and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome. Perspectives The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic non-malignant pain conditions.

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“…A high level of pain intensity “per se”, however, does not seem to be clinically an intrinsic factor, as it may possibly depend on several factors. For example, it may result from a previous undertreatment, which could be potentially resolved in a simple way and could not influence the prognosis . The multicenter nature of the study, with unselected settings using different procedures of opioid titration and no clear definition of some variables, could have influenced the data.…”

Section: Introductionmentioning

confidence: 99%

“…For example, it may result from a previous undertreatment, which could be potentially resolved in a simple way and could not influence the prognosis. 6 The multicenter nature of the study, with unselected settings using different procedures of opioid titration and no clear definition of some variables, could have influenced the data. For instance, original data suggested a delayed recourse to strong opioids in a substantial percentage of patients.…”

Section: Introductionmentioning

confidence: 99%

Pain Intensity as Prognostic Factor in Cancer Pain Management

et al. 2014

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Aim The aim of this study was to prospectively assess the prognostic value of initial pain intensity and its duration in advanced cancer patients. Methods A prospective study was conducted in a sample of patients with cancer requiring pain control. Patients underwent standard analgesic strategies used in our palliative care units. Pain intensity was measured at admission (T0) and after successful dose titration or opioid/route switching within a week (Ts). Patients were also asked about their pain intensity reported 15 days before admission (T‐15). Doses of opioids and duration of opioid use were recorded. Patients were also assessed for the presence of incident pain, neuropathic pain, alcoholism, delirium, and symptom intensity, including items representing psychological distress. One week after or at time of stabilization (Ts), the opioid response was clinically graded as follows: (1) good pain control; (2) adequate pain control requiring more aggressive opioid escalation; (3) adequate pain control associated with the occurrence of adverse effects; (4) incapacity to achieve pain control within a week. Opioid escalation indexes and days for dose finding were also recorded. Results Pain intensity at T0 and at T‐15, opioid doses, duration of opioid therapy, and age were associated with more complex analgesic therapies, which were effective in almost all patients within a week. Conclusion High levels of pain intensity, often due to previous undertreatment, are predictive of more complex analgesic treatment. Opioid tolerance, as well as younger age, may also play a role.

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Does pain intensity predict a poor opioid response in cancer patients?

Cited by 16 publications

References 17 publications

Cancer-Related Pain: A Longitudinal Study of Time to Stable Pain Control and Its Clinicodemographic Predictors

Cancer-Related Pain: A Longitudinal Study of Time to Stable Pain Control and Its Clinicodemographic Predictors

Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

Pain Intensity as Prognostic Factor in Cancer Pain Management

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