Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey

Abstract

We report on epidemiology, features, outcome, and domiciliary management of pain in patients with advanced hematological malignancies followed by an experienced hospital-based home care (HC) team. Out of 469 patients, 244 (52%) experienced a total of 284 pain syndromes. Pain intensity was rated from mild to moderate in 31% and from moderate to severe in 69% of them. The diagnosed pain mechanisms were deep somatic in 56%, superficial somatic in 15%, visceral 14%, mixed 8%, and neuropathic in 7% of pain syndromes, respectively. Incident pain was observed in 38% of all pain syndromes. In every diagnostic group, deep somatic pain was prevalent. Moreover, 85% of visceral pain syndromes were observed in patients affected by non-Hodgkin's lymphoma (NHL). In addition, out of 284 pain syndromes, 150 (51%) were caused by bone involvement. The most frequent recognized pain provocative mechanisms were bone marrow expansions, osteolysis, lymph node enlargement, and mucositis. In our experience, an approach based on the association of causal therapies and analgesics allows optimal control of most pain syndromes. Therefore, pain is a major problem in patients affected by advanced hematological malignancies, and its management can be effective and feasible when carried out by a skilled HC team.

Effective pain management in hematological malignancies

“…Indeed, 157 out of 421 patients experienced a total of 223 pain syndromes [5]. In another study on patients with advanced disease followed at home, pain was reported in 244 (52%) out of 469 patients, who experienced a total of 284 pain syndromes [4], with some patients experiencing pain in two or more places at the same time and/or during the disease course.…”

“…Given the scarcity of epidemiological data and of treatment guidelines and protocols specifically developed in this setting, the awareness of this potentially devastating symptom by hematologists may be inadequate and, consequently, the pain may not be appropriately managed [1]. However, some recent experiences claimed that the burden of this symptom in HM patients may be potentially relevant [2][3][4][5].…”

“…Most pain syndromes caused by the disease and its complications were diagnosed as being a result of BM involvement, compressing organomegalies and lymphadenomegalies, osteolysis, meningeal disease, mucosal damage, herpes zoster neuralgia and, in a minority of cases, other causes [4].…”

“…Several pain syndromes may affect HM patients from the onset of their illnesses [5] to the most advanced phase [2][3][4]. Pain may be caused by the underlying malignancy [1], its complications [6], diagnostic procedures [7,8] or therapeutic interventions [9,10], or it may be unrelated to the disease process.…”

Epidemiology and pathogenesis of incident pain-related disability in malignant hematology: an Italian survey

“…IP strongly limits physical activity in most cancer patients, portraying a negative impact on their quality of life (QoL) 2 . IP 3,4 and motor disability (MD) 5,6 have been reported as common concerns for patients with hematological malignancies (HM), especially for those affected by multiple myeloma (MM) 7 . In order to explore the relationship between IP and MD we have conducted a 2-year observational study including a consecutive sample of 130 HM patients admitted to , very few information regarding their origins, frequency and relationship have been provided so far.…”