Cancer Pain Management: Is It Still Problematic?

Objective: To evaluate the efficacy of pain management during 3-month follow-ups for outpatients with cancer pain. Methods: A retrospective chart review was conducted and included all newly diagnosed cancer pain patients visiting the Siriraj Pain Clinic, Mahidol University, between January 2013 and June 2014. Demographic data, pain intensity at first visit, 1-, 2- and 3-month follow-ups, pharmacological therapy and co-treatments were collected. Good treatment response was defined as more than 30% pain reduction from baseline. Predictive factors associated with pain treatment response were also assessed. Results: Out of 432 new patients, 118 cancer pain patients were included in the study with a mean age of 59.8±13.7 years (range 18-91 years). About half of patients had at least one comorbidity. Over 90% of all cancer patients presented with distance metastasis. Mixed neuropathic/nociceptive pain (53.4%) and nociceptive pain alone (43.2%) were common pain features in cancer pain patients. The mean initial pain intensity described by verbal numerical scales was 7.7±2.1 (range 3-10). The majority of patients (60.2%) received co-treatment. The main pharmacological therapies in all patients were opioids (99.2%) and anticonvulsants (90.7%). At 3-month follow-up, nearly half of patients achieved a good treatment response. However, 44.6% of good responders still had moderate and severe pain. No predictive factors associated with the pain treatment response was found. Conclusion: Approximately half of patients with cancer pain in the pain clinic achieved a good treatment response whereas one-fifth of the patients had an increase in pain severity at their 3-month follow-up.