Psychosocial characteristics of cancer‐related pain in patients attending specialist pain clinics in Australia and New Zealand

Abstract

BACKGROUND Opioids have been the mainstay of cancer pain relief for the past 40 years, but a multidimensional, biopsychosocial approach to assessment and treatment is now recommended. 1 The intensity of cancer pain and the distress it causes are well known, but it is less clear what patients with cancer think about their pain and how they cope with it. The electronic Persistent Pain Outcomes Collaboration (ePPOC) is an integrated pain outcomes center established in Australia and New Zealand (ANZ) in 2013 to standardize data collection from patients attending outpatient pain clinics. Before their first clinic visit, patients self-report their demographics, clinical status (pain history, including a checklist for how they think their pain began; comorbidities; medications; health care utilization), and responses to four validated questionnaires-Brief Pain Inventory short form (BPI-SF), Depression Anxiety Stress Scales-21 (DASS-21), Pain Self-Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS). The aim of this study was to interrogate the ePPOC dataset to determine (1) pain intensity, pain interference, mood, and pain cognitions in patients with cancer-related pain (CRP), (2) how these data compare to those in patients with chronic non-cancer pain, and (3) whether demographic or clinical variables predict self-efficacy and catastrophizing in patients with CRP. 2 | METHODS 2.1 | Participants Ambulatory patients with chronic pain attending specialist pain clinics participating in the ePPOC initiative between June 2013 and December 2016 and who completed the pre-consultation questionnaire were included. Patients were identified as having CRP if they selected "related to cancer" from the how-pain-began checklist. The study was approved by the University of Sydney Human Research Ethics Committee. 2.2 | Questionnaires and their categorization Patients self-reported responses to the following questionnaires: • BPI-SF: assesses pain intensity and interference with activity and enjoyment of life in the past week. Clinically relevant cut-points for patients with cancer are 0 to 4 for mild, 5 to 6 for moderate and 7 to 10 for severe. 2 • DASS-21: assesses severity of depression, anxiety, and stress over the past week. For each subscale, scores are classified either as normal (0-9 for depression, 0-7 for anxiety, 0-14 for stress), mild (10-13 for depression, 8-9 for anxiety, 15-18 for stress), moderate (14-20 for depression, 10-14 for anxiety, 19-25 for stress), severe (21-27 for depression, 15-19 for anxiety, 26-33 for stress), or extremely severe (≥28 for depression, ≥20 for anxiety, ≥34 for stress). 3 • PSEQ: assesses how strongly the patient believes he or she can perform a range of activities despite pain. Lower scores indicate less confidence to perform. In this study, self-efficacy was categorized as 0 to 19 for severe, 20 to 30 for moderate, 31 to 40 for mild, ≥41 for minimal. 4 • PCS assesses helplessness, magnification, and rumination in relation to pain, higher scores being worse. The cut points used ...

Psychosocial characteristics of chronic pain in cancer survivors referred to an Australian multidisciplinary pain clinic

“…These data are collected routinely at the time of referral for an initiative known as the electronic Persistent Pain Outcomes Collaboration (ePPOC). 13 Our analysis again found that pain-related distress and disability were common in these patients with cancer pain, in association with low pain self-efficacy and high pain catastrophizing scores. An acknowledged limitation of the analysis was the paucity of clinical information collected by ePPOC.…”

“…We previously analyzed data on pain intensity, pain outcomes and pain cognitions in a national sample of patients with cancer pain referred to hospital‐based multidisciplinary pain clinics in Australia and New Zealand. These data are collected routinely at the time of referral for an initiative known as the electronic Persistent Pain Outcomes Collaboration (ePPOC) 13 . Our analysis again found that pain‐related distress and disability were common in these patients with cancer pain, in association with low pain self‐efficacy and high pain catastrophizing scores.…”

“…The findings and the generalizability of the study are limited by the data being collected from one Australian site. Although 7 years' worth of cases were reviewed, the sample size was small due to the low referral rate of cancer patients to chronic pain clinics in Australia 13 . As a result, some of the trends identified here may become significant with a larger sample.…”

“…Although 7 years' worth of cases were reviewed, the sample size was small due to the low referral rate of cancer patients to chronic pain clinics in Australia. 13 As a result, some of the trends identified here may become significant with a larger sample. A prospective, multisite international survey using these standardized questionnaires is needed.…”

Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review

“…167 This correlation of increased pain severity and poor pain outcomes has been corroborated by other groups. 168 The impact of social constructs on pain and pain outcomes in cancer pain has been reported in a recent meta-analysis that identified that social support has been found to be associated with less postoperative pain after breast cancer surgery. 169 Furthermore, the presence of a strong social support network is associated with reduced cancer pain symptom burden, improved quality of life, and reduced distress in patients with chronic lymphocytic leukemia, 170 breast cancer, 171,172 and colorectal cancer.…”