Association among presence of cancer pain, inadequate pain control, and psychotropic drug use

Severity, interference, qualities, and correlates of severe pain: Descriptive cross-sectional study on pain experience of cancer patients in Sri Lanka

OBJECTIVE

Pain is the most debilitating and subjective experience of cancer patients. This study examines the severity, interference, characteristics, and associations of severe pain in Sri Lankan cancer patients.

METHODS

A descriptive study was conducted in Sri Lanka on 384 patients at age 18 or older who had cancer pain for 3 months or more due to the initial lesion, secondaries, radiation, or chemotherapy. Patients with non-cancerous pain or brain metastases were excluded. Data was collected using a validated Sinhala version of the Short-Form Brief Pain Inventory and the Short-Form McGill Pain Questionnaire-2. Logistic regression was used to identify severe pain correlations.

RESULTS

The mean of the "worst pain" experience was 7.97, and 73.2% reported their "worst pain" as severe. The "normal works" (62.5%) and "sleep" (58.3%) were severely influenced by pain. "Aching pain," was the most reported pain quality. A statistically significant association was shown between severe pain and male gender (adjusted odds ratio (AOR) = 1.723), being in marriage (AOR = 1.947), absence of family commitments (AOR = 1.8), and pain of 3 months or more duration (AOR = 1.76).

CONCLUSION

The experiences of cancer pain vary, with the majority suffering from severe pain.

Noninvasive Brain Stimulation for Cancer Pain Management in Nonbrain Malignancy: A Meta-Analysis

Purpose. Noninvasive brain stimulation (NIBS) has been reported to have analgesic effects on fibromyalgia and chronic neuropathic pain; however, its effects on cancer pain have yet to be determined. The present study aimed to evaluate the effects of NIBS on patients with pain secondary to nonbrain malignancy. Methods. Electronic databases including PubMed, Embase, Cochrane Library, and Web of Science were searched from inception through June 5th, 2022. Parallel, randomized, placebo-controlled studies were included that enrolled adult patients with cancer pain, except for that caused by brain tumors, compared NIBS with placebo stimulation, and reported sufficient data for performing meta-analysis. Results. Four parallel, randomized, sham-controlled studies were included: two of repetitive transcranial magnetic stimulation (rTMS), one of transcranial direct current stimulation (tDCS), and one of cranial electrical stimulation (CES). rTMS significantly improved pain in the subgroup analysis (standardized mean difference (SMD): −1.148, 95% confidence interval (CI): −1.660 to −0.637, ( $p<0.001$ )), while NIBS was not benefited in reducing pain intensity (SMD: −0.632, 95% CI: −1.356 to 0.092, p = 0.087). Also, NIBS significantly improved depressive symptoms (SMD: −0.665, 95% CI: −1.178 to −0.153, p = 0.011), especially in the form of rTMS (SMD: −0.875, 95% CI: −1.356 to −0.395, $p<0.001$ ) and tDCS (SMD: −1.082, 95% CI: −1.746 to −0.418, p = 0.001). Conclusion. rTMS significantly improved pain secondary to nonbrain malignancy apart from other forms of NIBS without major adverse events.

Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis

Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.

Psychotropic and Opioid-Based Medication Use among Economically Disadvantaged African-American Older Adults

African-American older adults, particularly those who live in economically deprived areas, are less likely to receive pain and psychotropic medications, compared to Whites. This study explored the link between social, behavioral, and health correlates of pain and psychotropic medication use in a sample of economically disadvantaged African-American older adults. This community-based study recruited 740 African-American older adults who were 55+ yeas-old in economically disadvantaged areas of South Los Angeles. Opioid-based and psychotropic medications were the outcome variables. Gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), continuity of medical care, health management organization membership, sleeping disorder/insomnia, arthritis, back pain, pain severity, self-rated health, depressive symptoms, and major chronic conditions were the explanatory variables. Logistic regression was used for data analyses. Arthritis, back pain, severe pain, and poor self-rated health were associated with opioid-based medications. Pain severity and depressive symptoms were correlated with psychotropic medication. Among African-American older adults, arthritis, back pain, poor self-rated health, and severe pain increase the chance of opioid-based and psychotropic medication. Future research should test factors that can reduce inappropriate and appropriate use and prescription of opioid-based and psychotropic medication among economically disadvantaged African-American older adults.

Cancer Patients and Anxiety: A Gender Perspective

The complexity of the diagnosis and treatment of cancer means that it is often associated with anxiety symptoms. The aim of our study was to further our understanding of the oncological process and the presence of anxiety symptoms, from a gender perspective. A cross-sectional study was performed, examining 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Data collection took place between February and May 2015. Psychiatric and sociodemographic variables were gathered, as well as pain variables and information regarding the oncological process. The data analysis included a descriptive univariate analysis and a bivariate analysis, and a logistic regression model was performed. Our results suggest that women with cancer suffer more anxiety symptoms than men with cancer. Women with anxiety symptoms represented 76.5% of all patients with anxiety. The OR of suffering anxiety symptoms between women and men was 2.43 (95% CI 1.05–5.63) (p = 0.04). A greater incidence of anxiety symptoms was found in patients with cancer pain and oncological treatment with biological therapy. Our results suggest that the gender perspective is necessary in the management of mental health in patients with cancer. Nonetheless, further studies are necessary to confirm our findings.