Dr Clare Rayment, Consultant in Palliative Medicine, Marie Curie Hospice, Bradford, UK, explains the background to a longer article that has been selected as ‘Editor’s choice’ in the September edition of Palliative Medicine.
I am a consultant in palliative medicine working in the UK. Many of my patients have pain which can be severe and affects all aspects of their lives. Most, but not all these patients, have pain caused by their cancer. Despite great advancements in the understanding and treatment of cancer pain, some patients still have pain that can be difficult to treat. This can be distressing not only to the patients and family but also to the health care professionals involved.
Doctors tend to divide pain into two types: nociceptive and neuropathic. Neuropathic pain is a problem with the nervous system; nociceptive pain is a problem with the organs, tissues or bones. Knowing which sort of pain a person has is important because it alters what treatment would be best for managing the pain.
We know that if we can understand how pain affects people in greater detail we are likely to be better at treating it. Pains can be caused by many different things. Lots of the evidence about neuropathic pain’s impact and treatment has been based on studies that have looked at non-cancer pain and therefore may not be completely accurate for a cancer patient. Studies have shown that in non-cancer neuropathic pain patients experience greater pain intensity and worse quality of life than patients with non-cancer nociceptive pain: we did not know if this was true for cancer patients.
Our study, which was published in the September issue of Palliative Medicine, looked at a database or more than 1,000 patients across Europe. This database was made available by the work of the European Association for Palliative Care. We looked to see whether there were any differences between the impact of neuropathic cancer pain and nociceptive cancer pain on patients. Our paper shows that neuropathic cancer pain has a greater negative impact on daily living than nociceptive cancer pain. In addition, patients with neuropathic cancer pain were more likely to have more treatments for their cancer, need more analgesics and reported worse daily function.
Deciding whether a patient has neuropathic or nociceptive pain is not easy. Many tools exist to help doctors decide whether a pain is more or less likely to be neuropathic in nature. Just as the evidence about neuropathic pain’s impact and treatment is mainly based on pains that have not been caused by cancer, the evidence supporting these tools is also mainly based on pains not caused by cancer. We looked at these scales in this group of patients with cancer and found that they seemed to work less well in distinguishing between neuropathic and nociceptive pains in cancer patients.
Knowing that neuropathic cancer pain has a greater negative effect on patients than nociceptive pain, and that some of the tools used in the non-cancer population may not work as well for cancer patients, means that more research needs to be done to establish how patients get neuropathic cancer pain so that it can be targeted more effectively. This should mean that patient’s pain will be better managed.
To find out more…
This post relates to a longer article, ‘Neuropathic cancer pain: prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative Computerised Symptom Assessment study’ by Clare Rayment, Marianne J Hjermstad, Nina Aass, Stein Kaasa, Augusto Caraceni, Florian Strasser, Ellen Heitzer, Robin Fainsinger, Michael I Bennett, and on behalf of the European Palliative Care Research Collaborative (EPCRC). Palliative Medicine, September 2013, 27: 714-721. First published on 21 November 2012, Doi: 10.1177/0269216312464408.
EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘Editor’s choice’ papers from the EAPC website. (Just follow the instructions in the top right-hand corner of EAPC home page to register or login, and scroll down to download the article). Click here to view other EAPC-originated papers on the EAPC website.