Pattern of Cancer Pain in Patients Admitted at a Tertiary Care Centre in Northern India- A Prospective Observational Study

Abstract

Aims: Pain being the commonest symptom in cancer, its prevalence and pattern needs to be studied. The aim of this study was to evaluate the prevalence and pattern of cancer pain in admitted patients. Study Design: Prospective observational study. Place and Duration of Study: This study was carried out at Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India, between January 2018 and April 2018. Methodology: After institutional ethical clearance and written informed consent 393 patients were enrolled in the study. We prospectively evaluated patients admitted with diagnosis of cancer for presence, severity and pattern of pain, using clinical assessment and numerical pain scale at admission and at discharge. Chi-square test was used for categorical data and multivariate analysis was performed with multinominal regression and ANNOVA tests. Results: In 393 patients prevalence of pain, moderate-severe pain, neuropathic pain (NPP), mixed pain was 67%, 47.8%, 10.2% and 31.9% respectively. More than one pain site was present in 43% of patients. The median numerical pain score was 2 overall, 4 in patients with pain and 7 in patients with NPP or mixed pain. Prevalence of severe pain and NPP or mixed pain was highest in hepatobilliary, lung, head and neck and genitourinary cancers. As many as 42.97% (113/263) patients had more than one pain site. On multivariate analysis severity of pain was significantly associated with primary tumor site (P=0.002), NPP (P=0.000), number of metastatic sites (P=0.02) and number of pain sites (P=0.009); NPP with primary tumor site (P=0.000), number of pain sites (P=0.000) and severity of pain(P=0.014). The proportion of patients with moderate-severe pain reduced from 47.8% before admission to 10.7% at discharge with adequate analgesic management. Conclusion: The prevalence of cancer pain and moderate-severe pain is high in admitted patients. Various patient, disease and pain variables need to be considered for an adequate cancer pain assessment and management. Team approach with active participation of primary medical team, adjunct support from palliative care specialist is desirable for cancer pain management.