Which variables are associated with pain intensity and treatment response in advanced cancer patients?--Implications for a future classification system for cancer pain.
BACKGROUND
This study is part of a research program to reach consensus on an international cancer pain classification system. A confirmative and explorative approach was applied to investigate which of the variables identified in the literature, by experts and patients that are associated with pain.


METHODS
Data from an international, multicentre, cross-sectional study of cancer patients treated with opioids were investigated. Dependent variables were: average pain, worst pain, and pain relief (11-point Numerical Rating Scales). Forty-six independent variables were chosen based upon previous studies. Bivariate analyses identified independent variables associated with at least one of the dependent ones; 21 were included in multivariate linear regression analyses.


RESULTS
Two thousand two hundred and seventy-eight patients were investigated; 52% males, mean age 62 years, mean Karnofsky Performance Status 59%, mean daily opioid oral equivalent dose 341 mg. Fifty-eight percent had breakthrough pain. Mean pain scores were: average pain 3.5, worst pain 5.3 and pain relief 74%. Variables most strongly associated with these three dependent variables were: breakthrough pain, psychological distress, sleep, and opioid dose.


CONCLUSIONS
Breakthrough pain and psychological distress were confirmed as key variables of a future classification system. Candidate variables were: sleep, opioid dose, pain mechanism, use of non-opioids, pain localisation, cancer diagnosis, location of metastases, and addiction.
Knudsen
Anne Kari
AK
European Palliative Care Research Centre, Faculty of Medicine, NTNU, NO-7006 Trondheim, Norway. anne.k.knudsen@ntnu.no
Brunelli
Cinzia
C
Kaasa
Stein
S
Apolone
Giovanni
G
Corli
Oscar
O
Montanari
Mauro
M
Fainsinger
Robin
R
Aass
Nina
N
Fayers
Peter
P
Caraceni
Augusto
A
Klepstad
Pål
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D010146:Pain / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid