Evaluating treatment modalities in chronic pain treatment by the multi-criteria decision making procedure

Ender Sir,Gül Didem Batur Sir

doi:10.1186/s12911-019-0925-6

Abstract

BackgroundChronic pain is one of the most common complaints of cancer patients. There are many pharmacological and non-pharmacological treatment modalities used for the treatment of pain. Nonetheless, non-pharmacological interventions are preferred because of potential side effects in cases resistant to medical therapy that require a dose increase or potent drug use. In most real-life situations, the decision on which technique to choose is based on the clinical but subjective decisions of the practitioners. This study aimed to find out the best non-pharmacological treatment option for patients with chronic cancer pain by following a rational and reasonable approach.MethodsSince the evaluation of treatment options requires to make a comparison between a number of alternatives in the light of certain criteria, we utilize the order relation analysis (G1-method) which is a method for determining the weights based on the improved Analytic Hierarchy Process (AHP). The method uses the relative importances on prioritizing the four criteria and eight sub-criteria defined by the experts of three pain physicians, one oncologist, and one oncologic surgeon. Four alternatives are then compared according to the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) using the verbal subjective judgments of the practitioners.ResultsObtained results indicate that the general medical condition of the patient and the stage of the cancer are the essential factors in the selection of the treatment method. It is followed by the extent of the pain and the level of evidence, respectively. According to the evaluations performed, spinal port and splanchnic nerve radiofrequency thermocoagulation treatments are the first and second priority methods for pain treatment, respectively, compared to lumbar epidural catheter and celiac plexus block.ConclusionsThe results of this study emphasize the need to integrate critical criteria into the decision-making process objectively. This is the first study in which multi-criteria decision-making tools are used in the evaluation and selection of pain management methods in cancer patients.

Highlights

Chronic pain is one of the most common complaints of cancer patients
Determination of the weights of criteria After defining the important criteria for the goal of selecting the best treatment alternative among the four non-pharmacological methods for the chronic pain observed in upper abdominal malignancy patients; we find out which one(s) among these criteria are more important over this decision, and determine which treatment method suits best to this specific group of patients
The procedure given in “Methods” section is applied to the problem of selecting the best non-pharmacological intervention method used in cancer patients

Summary

Introduction

Chronic pain is one of the most common complaints of cancer patients. There are many pharmacological and non-pharmacological treatment modalities used for the treatment of pain. Chronic pain is defined as persistent pain, which lasts longer than three months, and usually requires longterm treatment. It is a global health problem and is present in the range of one-third to 50 % of the population [1]. Chronic pain, which affects millions of people every year, is the most common cause of disability and is the most important cause for reducing the life quality. It is problematic for the community, in terms of Cancer patients are among the most frequently concerned focus groups having chronic pain.

Objectives

Methods

Results

Discussion

Conclusion