Personalized Pain Goals and Responses in Advanced Cancer Patients

Sebastiano Mercadante, Claudio Adile, Federica Aielli, Lanzetta Gaetano, Kyriaki Mistakidou, Marco Maltoni, Luiz Guilherme Soares, Stefano Desantis, Patrizia Ferrera, Marta Rosati, Romina Rossi, Alessandra Casuccio

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the personalized pain intensity goal (PPIG), the achievement of a personalized pain goal response (PPGR), and patients' global impression (PGI) in advanced cancer patients after a comprehensive pain and symptom management. Design: Prospective, longitudinal Setting: Acute pain relief and palliative/supportive care. Subjects: 689 advanced cancer patients. Methods: Measurement of Edmonton Symptom Assessment Score (ESAS) and personalized pain intensity goal (PPIG) at admission (T0). After a week (T7) personalized pain goal response (PPGR) and patients' global impression (PGI) were evaluated. Results: The mean PPIG was 1.33 (SD 1.59). A mean decrease in pain intensity of - 2.09 was required on PPIG to perceive a minimal clinically important difference (MCID). A better improvement corresponded to a mean change of - 3.41 points, while a much better improvement corresponded to a mean of - 4.59 points. Patients perceived a MCID (little worse) with a mean increase in pain intensity of 0.25, and a worse with a mean increase of 2.33 points. Higher pain intensity at T0 and lower pain intensity at T7 were independently related to PGI. 207 (30.0%) patients achieved PPGR. PPGR was associated with higher PPIG at T0 and T7, and inversely associated to pain intensity at T0 and T7, and Karnofsky level. Patients with high pain intensity at T0 achieved a favorable PGI, even when PPIG was not achieved by PPGR. Conclusion: PPIG, PPGR and PGI seem to be relevant for evaluating the effects of a comprehensive management of pain, assisting decision-making process according to patients' expectations. Some factors may be implicated in determining the individual target and the clinical response.

Original languageEnglish
Pages (from-to)E215-E221
JournalPain Medicine (United States)
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 1 2020

Keywords

  • Cancer Pain
  • Clinical Response
  • Pain Intensity

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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