Aim: to compare the pain characteristics of patients attending Australian pain clinics according to whether they self-report cancer as a comorbidity or not.
Methods: Cross sectional study of questionnaire scores in the national pain clinic registry established under the electronic Persistent Pain Outcomes Collaborative (ePPPOC) initiative. All patients completed the Brief Pain inventory, Depression Anxiety Stress Scale, Pain Self Efficacy Questionnaire, and Pain Catastrophizing Scale.
Results: As of 31 December 2014, some 13,528 patients’ questionnaires were available for analysis in the ePPOC registry. 594 recorded cancer as a comorbidity. Another 84 attributed their pain to cancer without selecting cancer as a comorbidity. Together, they account for less than 2% of all cases in the registry. Many cancer patients attributed their pain to other causes. The percentage of patients with questionnaire scores in the severe range, according to whether they report cancer as a comorbidity or not and attributed their pain to cancer or not are shown in the Table below. While these differences are all highly statistically significant, they are not clinically different and indicate cancer patients have similar levels of severe pain, disability, distress and unhelpful thinking as patients with chronic non-malignant pain.
Conclusion: A biopsychosocial approach to pain management is likely to be necessary in patients with a history of cancer, especially when opioids are ineffective or undesirable (e.g. disease free cancer survivors). These findings also suggest that those dealing with pain in cancer survivors should consider using the ePPOC measures to evaluate and guide their pain management.
|
Cancer comorbidity |
yes |
yes |
no |
no |
|
Cancer causing pain |
yes |
no |
yes |
no |
|
n |
136 |
413 |
84 |
12,615 |
|
Pain intensity, severe |
25.7% |
42.2% |
23.2% |
35.0% |
|
Pain disability, severe |
42.2% |
54.8% |
36.6% |
55.9% |
|
Depression, severe |
37.9% |
36.6% |
35.0% |
47.4% |
|
Anxiety, severe |
31.8% |
55.9% |
37.5% |
41.6% |
|
pain self-efficacy, poor |
34.4% |
42.2% |
28.0% |
43.1% |
|
Catastrophizing, severe |
37.7% |
54.8% |
33.3% |
54.1% |