Pain intensity as prognostic factor in cancer pain management.
OBJECTIVE
The aim of this study was to prospectively assess the prognostic value of initial pain intensity and its duration in advanced cancer patients.


METHODS
A prospective study was conducted in a sample of patients with cancer requiring pain control. Patients underwent standard analgesic strategies used in our palliative care units. Pain intensity was measured at admission (T0) and after successful dose titration or opioid/route switching within a week (Ts). Patients were also asked about their pain intensity reported 15 days before admission (T-15). Doses of opioids and duration of opioid use were recorded. Patients were also assessed for the presence of incident pain, neuropathic pain, alcoholism, delirium, and symptom intensity, including items representing psychological distress. One week after or at time of stabilization (Ts), the opioid response was clinically graded as follows: (1) good pain control; (2) adequate pain control requiring more aggressive opioid escalation; (3) adequate pain control associated with the occurrence of adverse effects; (4) incapacity to achieve pain control within a week. Opioid escalation indexes and days for dose finding were also recorded.


RESULTS
Pain intensity at T0 and at T-15, opioid doses, duration of opioid therapy, and age were associated with more complex analgesic therapies, which were effective in almost all patients within a week.


CONCLUSIONS
High levels of pain intensity, often due to previous undertreatment, are predictive of more complex analgesic treatment. Opioid tolerance, as well as younger age, may also play a role.
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
Sebastiano
S
Mercadante
Giampiero
G
Porzio
Claudio
C
Adile
Federica
F
Aielli
Andrea
A
Cortegiani
Amanda
A
Caruselli
Alessandra
A
Casuccio
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009437:Neuralgia / Q000209:etiology; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013315:Stress, Psychological; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid
assessment tools; cancer; cancer pain; opioid; opioid analgesics; opioid response; pain assessment; pain intensity; pain measurement; prognostic factors