Does pain intensity predict a poor opioid response in cancer patients?
OBJECTIVE
The aim of this study was to test the hypothesis that initial pain intensity is not a predictive factor of poor opioid response in advanced cancer patients, as suggested by a recent work.


METHODS
A secondary analysis of one-hundred-sixty-seven patients referred for treatment of cancer-related pain was conducted. Pain intensity at admission was recorded and patients were divided in three categories of pain intensity: mild, moderate and severe. Patients were offered a treatment with opioid dose titration, according to department policy. Data regarding opioid doses and pain intensity were collected after dose titration was completed. Four levels of opioid response were considered: (a) good pain control, with minimal opioid escalation and without relevant adverse effects; (b) good pain control requiring more aggressive opioid escalation, for example doubling the doses in four days; (c) adequate pain control associated with the occurrence of adverse effects; (d) poor pain control with adverse effects.


RESULTS
Seventy-six, forty-four, forty-one and six patients showed a response a, b, c, and d, respectively. No correlation between baseline pain intensity categories and opioid response was found. Patients with response 'b' and 'd' showed higher values of OEImg.


CONCLUSIONS
Baseline pain intensity does not predict the outcome after an appropriate opioid titration. It is likely that non-homogeneous pain treatment would have biased the outcome of a previous work.
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Italy. terapiadeldolore@lamaddalenanet.it
Sebastiano
S
Mercadante
Vittorio
V
Gebbia
Fabrizio
F
David
Federica
F
Aielli
Lucilla
L
Verna
Giampiero
G
Porzio
Patrizia
P
Ferrera
Alessandra
A
Casuccio
Corrado
C
Ficorella
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid