The impact of pain reduction on other symptoms in patients with multiple myeloma-related painful vertebral fracture treated with kyphoplasty or vertebroplasty.

Abstract

e19536 Background: Patients with cancer pain usually have associated symptoms. Generally, it is felt that a reduction in severity of pain will be associated with significant improvement in other symptoms as well. Patients with multiple myeloma (MM)-related painful vertebral compression fracture often show substantial reduction in pain after kyphoplasty (KP) or vertebroplasty (VP). We evaluated the association of changes in pain ratings with ratings of other cancer symptoms in this patient group. Methods: We retrospectively studied 79 patients with MM-related painful vertebral compression fracture who underwent KP or VP. The patients' ratings of pain and symptom severity using the Brief Pain Inventory (BPI) and the Edmonton Symptom Assessment Scale (ESAS), assessed both before and after undergoing KP or VP, were noted. Change scores and change score effect sizes were computed, and correlations were evaluated before and after treatment. Results: There were significant reductions in mean pain severity after treatment (1.8 on a 0-10 scale, p<.001). Effect-size reductions for the pain items ranged from 0.53 to 0.70. Also, significant reductions were noted (decreasing order) in anxiety (1.3, p<.001), drowsiness (1.3, p<.001), depression (0.80, p<.012), difficulty thinking clearly (0.79, p<.012), and fatigue (0.90, p<.028). Pain change scores were associated only with changes in anxiety. In contrast, depression change scores were related with all symptom change scores. Fatigue change scores were related to change scores in depression, anxiety, drowsiness, poor appetite, and insomnia. There were no significant differences between KP and VP in reducing pain. Conclusions: Most patients experienced pain reduction after KP or VP. Interestingly, while other symptoms were lower at follow up, pain reduction was significantly associated only with anxiety. The lack of a significant association between a reduction in pain with other symptoms suggests that simplistic views of symptom clusters need further evaluation and requires longitudinal examination. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen, Celgene, Millennium Celgene, Millennium Celgene, Medtronic, Inc., Millennium, Novartis