Epidemiology and Characteristics of Pain in Patients Suffering from Advanced Haematological Malignancies in the Home Care (HC) Setting: An Italian Survey.

Abstract

Background. The epidemiology of pain in patients with advanced haematological malignancies followed at home, 469 consecutive patients has been followed over a six years.Methods. Each pain syndrome (PS) was properly assessed and treated according to the WHO ladder. The pain intensity was reported by a Numerical Analogue Scale, which rated score ranging from 0 (no pain) to 10 (the most severe), or, in less complaint patients, by a verbal description. Each PS was classified as deep somatic, superficial somatic, neuropathic and mixed or unknown.Results. Of 469 patients, 258 (55%) were males; the median age was 67 (4–95) years. Out of 469 patients, 244 (52%) experienced almost one PS, for a total of 284, which intensity was rated from mild to moderate in 92 (31%) and from moderate to severe in 192 (69%) of them respectively. The 244 patients who experienced pain were significantly younger than those without pain (57 ± 21 versus 69±16, P< 0.0005). Moreover, the group of less than 20 old years patients presented a higher incidence of pain compared to others (85% versus 49%, P=0.0007). The patients affected by Multiple Myeloma (MM), Acute Lymphoblastic Leukaemia (ALL), non Hodgkin's Lymphomas (NHL) and Blastic Crisis showed a higher incidence of pain compared to other disease groups (P=0.0011). Among acute leukemias, ALL patients presented a higher incidence of pain compared to those affected by myeloblastic forms (79% versus 41%, P= 0.0002). An effective pain control was achieved within 24 hours in 259/284 (92%) without any admission. PS was diagnosed as deep somatic, superficial somatic, visceral, neuropathic and mixed (somatic + neuropathic) in the 56 %, 15 %, 14 %, 7 % and 8 % of the PS respectively. A higher incidence of deep somatic pain was recorded in all diagnosis groups. Moreover, out of the 39 visceral PS, 33 (85%) have been recorded among patients with NHL and 6 (15%) in the others (P=0.0001). MM patients presented a higher rate of the incident pain (P<0.001). The causative mechanisms of PS were directly referable to underlying diseases, to their clinical complications and to concomitant and unrelated conditions in the 69%, 22% and 9% of cases respectively. The most involved sites were: the spine (27%), the abdomen (20%), the legs (15%), the thorax (11%) and orofaringeal tract (10%).Conclusion. our data show that pain is a relevant problem in advanced onco-haematological patients, which mostly present disease-related PS, reflecting specific pathological activity of the underlying malignancy.Table 1Incidence of pain and distribution of pain syndromes among the haematological malignanciesMalignancyPP/TP (No)Incidence of pain (%)Pain Syndromes (No)MM35/399038ALL31/397940NHL77/1286089BC29/565234HD5/11455CLL10/244211AML28/694134MDS20/633222CMPD5/33188Others3/7433Total243/46952284PP: Pain Patients; TP: Total Patients, No: number, MM: Multiple Myeloma, ALL: Acute Lymphoblastyc Leukemia, NHL; Non Hodgkin's Lymphomas; BC: Blastic Crisis, HD: Hodgkin's Disease, CLL: Chronic Lymphocytic Leukemia, Acute Myeloblastyc Leukemia, MDS: Myelodysplastyc Syndromes, CMPD: Chronic Myeloproliferative Disorders.