Pain prevalence and treatment in patients with metastatic bone disease

Abstract

The accomplishment of successful pain treatment requires evaluation, characterization and quantification. The present study characterized pain and survival in a cohort of patients with cancer with bone metastasis who were treated with intravenous bisphosphonates. A total of 84 patients self-completed the Brief Pain Inventory (BPI) and 36-Item Short Form Survey (SF-36), between November 2010 and March 2011 with a 5-year survival follow-up as a surrogate marker of cancer burden. The median age was 62 years old (34–85), 64% of patients were female and 58% of these females had breast cancer. In the population, self-reported pain was 91.6%, with 29 patients (34.5%) reporting severe pain (score 7–10). Among these patients, only 13 (44.8%) presented a similar report to that of their clinical files and 5 were undergoing treatment with strong opioids (17.2%). A total of 45 patients (46%) had not been prescribed analgesic drugs, of these patients, 32 were treated with a weak opioid, and 13 with a strong opioid. An association was observed between pain records and the prescribed analgesic (P=0.031). BPI maximum pain and overall survival data were analyzed, and a significant association was identified between male patients presenting severe pain and decreased survival (P=0.004). Male survival was associated with severe pain, which is consistent with other data. The results revealed a skeletal-related events (SRE)-free survival (time elapsed from diagnosis of the first bone metastasis to the first SRE) of 9 months (4.39–13.73, 95% CI) with a statistically significant difference between subgroups of time since diagnosis of bone metastasis (P=0.005). The added value of the present study is the suggestion that complete and accurate pain narratives are mandatory and may contribute to the optimization of analgesia, and may help to increase survival rates. Optimal pain management for patients with cancer remains an urgent requirement.

Clinical Features in Metastatic Bone Disease with and without Pathological Fractures: A Comparative Study

“…Osteolytic types can be found with osteoblastic, nevertheless, osteolytic types are far more common and are related to skeletal-related events (SREs), including pathological fractures (7) . Most MBD patients involved were in the age group of above 50 years (70.3%), in line with studies conducted by Singh et al, which showed 77% (5,8) . BC was the most common tumor involved in MBD in this study (24.6%), followed by thyroid (14.1%), lung (10.9%) and lymphoma (7.8%).…”

“…In this study, the VAS found in breast MBD with pathological fractures was higher than those without pathological fracture. This could be associated with bone resorption mediated by osteoclast that often causes pain (8) . Lymphoma metastases (in this study all of them are Non-Hodgkin Lymphoma (NHL)) are MBD with the second-highest VAS, which is also associated with osteolytic lesions, especially in NHL (2) .…”

Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study

“…The most commonly used dose (8 Gy) provided complete response in only 22% of patients and partial response in 38%; other doses fail to provide response in the majority of patients (9). Despite updated guidelines for managing metastatic bone pain, many patients still feel moderate to severe pain (10)(11)(12). For these patients, systemic analgesics are the only remaining option (5,13).…”

The Burden of Metastatic Cancer–Induced Bone Pain: A Narrative Review

“… 55 A Portuguese study found even greater undertreatment of adults with self-reported metastatic bone pain, with 84% of patients with moderate to severe pain not treated with a strong opioid. 57 A multicountry study of analgesic and bone-targeting agent use in Europe found that 15% of patients with prostate cancer and moderate to severe pain from bone metastases were receiving only nonopioid analgesics, and another 33% were not receiving strong opioids. 58 However, in a French study, analgesic use (89.9%) and, in particular, opioid use (77.7%) were common in patients with lung cancer and bone metastases.…”