Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy.
BACKGROUND
Pain is common in head and neck cancer (HNC) patients and may be attributed to the malignancy and/or cancer treatment. Pain mechanisms and patient report of pain in HNC are expected to include both nociceptive and neuropathic components. The purpose of this study was to assess the trajectory of orofacial and other pain during and following treatment, using patient reports of neuropathic pain and nociceptive pain and pain impact.


METHODS
124 consecutive HNC patients receiving radiation therapy (RT) (95 men, 29 women; mean age: 54.7 +/- 12.3 years) participated in a patient-reported outcome (PRO) assessment. Patients completed the McGill Pain Questionnaire three times during therapy and 3 months following study entry.


RESULTS
The majority of patients related their pain to the tumor and/or cancer treatment. Whereas 59% reported their pain to be less severe than they expected, 29% were not satisfied with their level of pain despite pain management during cancer therapy. Worst pain was 3.0 +/- 1.3 on a 0- to 5-point verbal descriptor scale. Pain intensity was present at entry, highest at 2-week follow-up, declining towards the end of treatment and persisting at 3-month follow-up. The most common neuropathic pain descriptors chosen were aching (20%) and burning (27%); nociceptive words chosen were dull (22%), sore (32%), tender (35%), and throbbing (23%), and affective/evaluative descriptors were tiring (25%) and annoying (41%). 57% of patients reported continuous pain, and combined continuous and intermittent pain was reported by 79% of patients.


CONCLUSIONS
This study provides evidence that patients with HNC experience nociceptive and neuropathic pain during RT despite ongoing pain management. The affective and evaluative descriptors chosen for head and neck pain indicate considerable impact on quality of life even with low to moderate levels of pain intensity. These findings suggest that clinicians should consider contemporary management for both nociceptive and neuropathic pain in head and neck cancer patients.
Epstein
Joel B
JB
University of Illinois Cancer Center, University of Illinois, Chicago, USA.|University of Illinois College of Dentistry, University of Illinois, Chicago, USA.|Univerity of Illinois College of Medicine, University of Illinois, Chicago, USA.
Wilkie
Diana J
DJ
University of Illinois Cancer Center, University of Illinois, Chicago, USA.|University of Illinois College of Nursing, University of Illinois, Chicago, USA.
Fischer
Dena J
DJ
University of Illinois College of Dentistry, University of Illinois, Chicago, USA.
Kim
Young-Ok
YO
University of Illinois College of Nursing, University of Illinois, Chicago, USA.
Villines
Dana
D
University of Illinois College of Dentistry, University of Illinois, Chicago, USA.
D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology* / Q000628:therapy; D009619:Nociceptors / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement