Abstract
PurposeCancer pain is a multidimensional experience that includes physiological, sensory, affective, cognitive, behavioral, and sociocultural dimensions. Few prospective studies have examined the relationship between a patient’s expectation of pain improvement and the pain prognosis. The aim of this prospective study was to investigate whether patients’ expectation to pain reduction was associated with pain intensity after morphine treatment in opioid treatment-naïve patients with various types of cancer.MethodsThe subjects were patients scheduled for cancer pain treatment with morphine who were taking nonsteroidal anti-inflammatory drugs daily. Morphine treatment was performed according to the standard method, including titration (NCCN Guidelines™, Adult Cancer Pain). Simple regression analysis was performed between pain intensity numerical rating scale (NRS) (day 8) as the dependent variable, expectation of pain decrease NRS (day 1), tumor types, and the following covariates as independent variables: patients’ characteristics such as age, gender, PS (day 1), genotype of catechol-O-methyltransferase, total scores of Hospital Anxiety and Depression Scale (day 1), and pain intensity NRS (day 1). Multiple regression analysis was performed using forced entry methods with pain intensity NRS (day 8) as the dependent variable, and expectation of pain decrease NRS (day 1) and the covariates as independent variables that had a p value <0.05 in the simple regression models.ResultsA total of 100 patients with baseline data were included, and 97 patients (51% female) met the inclusion criteria. Patients with a high expectation of pain decrease NRS had a significantly lower pain intensity NRS (day 8) (p = 0.001).ConclusionNon-pharmacological factors such as expectations for pain treatment could also be important factors to treat cancer pain, which might be associated with communication skills in physicians.
Highlights
Pain is a common symptom in cancer patients [1, 2] that increases in prevalence and intensity with disease progression [3, 4] and influences multiple domains of quality of life [5,6,7,8]
The results of this study show that patients with an expectation for pain decrease numerical rating scale (NRS) had a significantly lower pain intensity NRS
This is the first prospective study to examine the effect of an expectation of a change in pain before morphine treatment on pain score 1 week later in opioid-naïve patients with various cancers and performance status (PS)
Summary
Pain is a common symptom in cancer patients [1, 2] that increases in prevalence and intensity with disease progression [3, 4] and influences multiple domains of quality of life [5,6,7,8]. There is a need for a multifaceted approach to non-cancer chronic pain that includes the effects of catastrophizing (exaggeration of pain) [11] and expectation of pain improvement [12, 13]. These factors are related to pain severity, disorder, and prognosis and provide important information for psychosomatic treatment of non-cancer chronic pain [14]. There are several studies investigating the effect of expectation as a predictor for pain level in patients with non-specific low back pain and total joint arthroplasty [15, 16], and according to the systematic review, 15 of the 16 studies showed that positive expectations were associated with better health outcomes including pain [17]
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