Korean J Pain.  2023 Apr;36(2):253-267. 10.3344/kjp.22392.

Neuropathic pain feature in cancer-induced bone pain: does it matter? a prospective observational study

Affiliations
  • 1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

Background
Cancer-induced bone pain (CIBP) is considered to have both nociceptive and neuropathic components. However, the prevalence, risk factors, and impact of the neuropathic components are yet poorly understood.
Methods
We estimate the prevalence of neuropathic pain (NP) features in patients with CIBP at a tertiary care pain clinic setting using the Douleur Neuropathique 4 questionnaire and evaluate their associated factors and their impact after 4 weeks of treatment using the Brief Pain Inventory questionnaire and the Edmonton Symptom Assessment System.
Results
A total of 133 patients were recruited. The estimated prevalence of NP was 30.8% (95% confidence interval: 23.6%–39.1%). Initially, the patients with NP had significantly higher average pain scores (6.00 vs. 5.05, P = 0.006), higher total interference scores (5.84 vs. 4.89, P = 0.033), and symptom distress scores (35.88 vs. 26.52, P = 0.002). After 4 weeks of treatment, patients in both groups reported significantly decreased pain intensity and improved quality of life. However, the patients with NP still reported significantly higher average pain (4.61 vs. 3.58, P = 0.048), trending toward higher total interference scores (3.52 vs. 2.99, P = 0.426), and symptom distress scores (23.30 vs. 20.77, P = 0.524). From multivariate analysis, the independent risk factors for NP were younger age, pain in the extremities, and higher average pain scores.
Conclusions
NP are common in patients with CIBP. These conditions negatively affect pain intensity and the patient’s quality of life before and after treatment.

Keyword

Bone Neoplasms; Neuralgia; Nociception; Pain Measurement; Prevalence; Risk Factors; Symptom Assessment; Surveys and Questionnaires; Quality of Life

Figure

  • Fig. 1 CONSORT flow diagram. DN4: Douleur Neuropathique 4.

  • Fig. 2 Bar chart illustrating comparisons of the percentage of patients having each neuropathic symptom between non-neuropathic and neuropathic group. A P value of less than 0.05 indicates statistical significance.

  • Fig. 3 Line graph showing changes of average pain score between baseline and week 4. *Independent t-test was used and a P value of less than 0.05 indicates statistically significant difference between two groups at baseline and week 4. aPaired t-test demonstrated statistically significant difference between average pain score of patients in non-neuropathic group at baseline and week 4 (P <0.001). bPaired t-test demonstrated statistically significant difference between average pain score of patients in neuropathic group at baseline and week 4 (P = 0.003).

  • Fig. 4 Line graph showing changes of total interference score of Brief Pain Inventory between baseline and week 4. *Independent t-test was used and a P value of less than 0.05 indicates statistically significant difference between two groups at baseline. aPaired t-test demonstrated statistically significant difference between total interference score of patients in non-neuropathic group at baseline and week 4 (P <0.001). bPaired t-test demonstrated statistically significant difference between total interference score of patients in neuropathic group at baseline and week 4 (P = 0.013).

  • Fig. 5 Line graph showing changes of symptom distress score of Edmonton Symptom Assessment Scale between baseline and week 4. *Independent t-test was used and a P value of less than 0.05 indicates statistically significant difference between two groups at baseline. aPaired t-test demonstrated statistically significant difference between symptom distress score of patients in non-neuropathic group at baseline and week 4 (P = 0.040). bPaired t-test demonstrated statistically significant difference between symptom distress score of patients in neuropathic group at baseline and week 4 (P = 0.002).

  • Fig. 6 Box plot showing differences of Brief Pain Inventory (BPI) between baseline and week 4. Mann–Whitney U-test was used and a P value of less than 0.05 indicates statistical significance.

  • Fig. 7 Box plot showing differences of Edmonton Symptom Assessment Scale (ESAS) between baseline and week 4. Mann–Whitney U- test was used and a P value of less than 0.05 indicates statistical significance. a demonstrates statistically significant difference between two groups.


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