title: Neuropathic Pain Features in Patients with Bone Metastases.
abstract: OBJECTIVE
  The results of previous randomised controlled trials suggest that radiation oncologists should consider the presence of neuropathic pain when they prescribe dose fractionations for painful bone metastases. Although validated screening tools for neuropathic pain features are currently available, the prevalence of such features among patients with painful bone metastases is still poorly understood. The purpose of this study was to estimate the prevalence of neuropathic pain features among patients who received palliative radiotherapy for painful bone metastases.
  
  
  METHODS
  We conducted a cohort survey of consecutive patients who received palliative radiotherapy for painful bone metastases at St Luke's International Hospital between 2013 and 2014. Patients were prospectively assessed before radiotherapy using the validated screening questionnaire to identify neuropathic pain components in Japanese patients. Pain with neuropathic features was prospectively defined using the total score of the seven-item questionnaire and a cut-off score ≥9. The pain response was assessed 2 months after the start of radiotherapy according to the criteria defined by the International Bone Metastases Consensus Working Party.
  
  
  RESULTS
  Eighty-seven patients were assessed. Twenty-four per cent of patients (95% confidence interval: 16-35%) were diagnosed as having pain with neuropathic features. On multivariate analysis, no significant correlations were seen between neuropathic pain features and patient characteristics. Sixty-four patients (74%) were assessable 2 months after the start of radiotherapy. Overall response rates were 59% (95% confidence interval: 33-82%) in patients with neuropathic features and 55% (95% confidence interval: 40-70%) in those without such features.
  
  
  CONCLUSIONS
  A considerable proportion of the patients were proven to have bone pain with neuropathic features. Further investigations are warranted to validate symptom assessment tools in cooperation with pain distribution and image findings, and to clarify if the presence of neuropathic pain affects the response to palliative radiotherapy.
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan. Electronic address: naoknaka@east.ncc.go.jp.
authors.forename: N
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Takahashi
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Zenda
authors.affiliation: Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kawamori
authors.affiliation: Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ogita
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Onozawa
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Arahira
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Toshima
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Motegi
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hirano
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Hojo
authors.affiliation: Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Akimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis* / Q000209:etiology; D010147:Pain Measurement; D010166:Palliative Care; D015995:Prevalence; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Bone metastases; neuropathic pain; palliative radiotherapy; radiotherapy