Evaluation of pain in cancer patients: A cross-sectional study and review of the literature

Received: 11-Apr-2023, Manuscript No. OAR-23-95217; Accepted: 29-Apr-2023, Pre QC No. OAR-23-95217 (PQ); Editor assigned: 13-Apr-2023, Pre QC No. OAR-23-95217 (PQ); Reviewed: 25-Apr-2023, QC No. OAR-23-95217 (Q); Revised: 28-Apr-2023, Manuscript No. OAR-23-95217 (R); Published: 30-Apr-2023

Introduction

Cancer is a leading cause of morbidity and mortality worldwide, and pain is a common symptom experienced by cancer patients. Pain can result from the disease itself or its treatment and can significantly affect the quality of life and overall well-being of cancer patients. Pain management in cancer patients is often challenging due to the complexity of cancer pain and the potential for adverse effects of analgesics.

The purpose of this study was to evaluate the prevalence, severity, and management of pain in cancer patients and to review the literature on pain assessment and management in this population.

Literature Review

A cross-sectional study was conducted in medical oncology department CHU Hassan II Fes in which cancer patients was evaluated for pain using the Numeric Rating Scale (NRS). The NRS is a simple and widely used tool for assessing pain severity, with scores ranging from 0 (no pain) to 10 (worst imaginable pain). Pain management strategies were recorded, including the type of analgesics used, dose, and frequency of use.

The study also included a review of the literature on pain assessment and management in cancer patients.

The study included 100 cancer patients, of whom 63% reported experiencing pain. The average pain score on the NRS was 6.5 out of 10. The most common types of pain reported were dull aching pain (52%) and sharp shooting pain (28%). The majority of patients (72%) reported using analgesics for pain management, with the most common analgesics being nonsteroidal antiinflammatory drugs (NSAIDs) (40%) and opioids (30%) (Table 1).

Tab. 1. Characteristic of patients study

The literature review revealed that pain assessment and management in cancer patients can be challenging due to the complexity of cancer pain and the potential for adverse effects of analgesics. Several tools have been developed for pain assessment in cancer patients, including the Brief Pain Inventory (BPI) of figure 1 and the Edmonton Symptom Assessment System (ESAS) of figure 2. The BPI is a multidimensional tool that assesses pain severity, interference with daily activities, and pain relief. The ESAS is a simple and quick tool that assesses multiple symptoms, including pain, nausea, fatigue, and anxiety. Both tools have been shown to be reliable and valid in assessing pain in cancer patients

Figure 1: The Brief Pain Inventory (BPI)

Figure 2: Edmonton Symptom Assessment System (ESAS)

Discussion

The present study aimed to evaluate pain in cancer patients and to review the literature on pain assessment and management in cancer patients. The study findings revealed that pain is a common problem among cancer patients, with the majority of patients experiencing moderate to severe pain. This is consistent with previous studies reporting that up to 70% of cancer patients experience pain [1].

The study also found that the most common types of pain reported by cancer patients were dull aching pain and sharp shooting pain, which is consistent with the literature. The use of analgesics for pain management was also high among the study participants, with NSAIDs and opioids being the most commonly used analgesics. This is consistent with the literature, which suggests that opioids are the mainstay of treatment for moderate to severe cancer pain [2].

The management of cancer pain is an important part of cancer care, and it involves a multidisciplinary approach that includes pharmacological and non-pharmacological interventions. Pharmacological interventions include opioids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and adjuvant medications such as antidepressants and anticonvulsants. Non-pharmacological interventions include physical therapy, relaxation techniques, and cognitive-behavioural therapy [1].

There are various guidelines and recommendations for the management of cancer pain, including those by the World Health Organization (WHO) and the American Pain Society (APS). The WHO's analgesic ladder is a widely used approach to cancer pain management, which involves starting with non-opioid analgesics and progressing to stronger opioids as needed [3]. The APS has also developed guidelines for the use of opioids in the treatment of chronic pain, including cancer pain.

Cancer pain can be complex and multifactorial, and it can affect patients physically, emotionally, and socially. Therefore, an effective pain management strategy should be individualized, patient-centred, and based on a comprehensive pain assessment. A pain assessment typically includes evaluating the location, intensity, quality, duration, and impact of pain on the patient's daily activities, as well as any factors that may exacerbate or alleviate the pain [4].

Pharmacological interventions are often the first line of treatment for cancer pain, and opioids are the most commonly used analgesics for moderate to severe pain. Opioids work by binding to specific receptors in the brain and spinal cord, thereby reducing the transmission of pain signals. However, opioids can have side effects such as nausea, constipation, sedation, and respiratory depression, and they can also be associated with the risk of addiction and abuse [4,5].

Non-opioid analgesics such as NSAIDs, acetaminophen, and corticosteroids can also be used alone or in combination with opioids to provide pain relief. Adjuvant medications such as antidepressants and anticonvulsants can also be used to treat neuropathic pain, which is often difficult to manage with opioids alone [4,5].

Non-pharmacological interventions can also be helpful in managing cancer pain. Physical therapy, including exercises and stretching, can help relieve muscle tension and improve mobility. Relaxation techniques such as deep breathing, meditation, and guided imagery can help reduce anxiety and stress, which can exacerbate pain. Cognitive-behavioural therapy, which involves changing negative thoughts and behaviours related to pain, can also be effective in reducing pain severity and improving quality of life [6].

In addition to medication and non-medication interventions, cancer pain management may also involve invasive procedures such as nerve blocks, radiation therapy, and surgery. These interventions may be recommended when other treatments have not been effective or when the pain is localized to a specific area [4-6].

Conclusion

Pain is a common and significant problem for cancer patients, affecting their quality of life and overall well-being. Assessment and management of cancer pain should be comprehensive and individualized, considering the nature and severity of pain, potential adverse effects of analgesics, and patients' preferences and values. Nonpharmacologic interventions should also be considered as part of pain management strategies for cancer patients. Further research is needed to identify optimal pain assessment and management strategies for different types of cancer pain and to improve the overall quality of care for cancer patients.

References

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