Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain

Anne Kari Knudsen, Cinzia Brunelli, Stein Kaasa, Giovanni Apolone, Oscar Corli, Mauro Montanari, Robin Fainsinger, Nina Aass, Peter Fayers, Augusto Caraceni, Pål Klepstad, European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS)

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: This study is part of a research program to reach consensus on an international cancer pain classification system. A confirmative and explorative approach was applied to investigate which of the variables identified in the literature, by experts and patients that are associated with pain. METHODS: Data from an international, multicentre, cross-sectional study of cancer patients treated with opioids were investigated. Dependent variables were: average pain, worst pain, and pain relief (11-point Numerical Rating Scales). Forty-six independent variables were chosen based upon previous studies. Bivariate analyses identified independent variables associated with at least one of the dependent ones; 21 were included in multivariate linear regression analyses. RESULTS: Two thousand two hundred and seventy-eight patients were investigated; 52% males, mean age 62years, mean Karnofsky Performance Status 59%, mean daily opioid oral equivalent dose 341mg. Fifty-eight percent had breakthrough pain. Mean pain scores were: average pain 3.5, worst pain 5.3 and pain relief 74%. Variables most strongly associated with these three dependent variables were: breakthrough pain, psychological distress, sleep, and opioid dose. CONCLUSIONS: Breakthrough pain and psychological distress were confirmed as key variables of a future classification system. Candidate variables were: sleep, opioid dose, pain mechanism, use of non-opioids, pain localisation, cancer diagnosis, location of metastases, and addiction.
Original languageEnglish
Pages (from-to)320-327
Number of pages8
JournalEuropean Journal of Pain
Volume15
Issue number3
DOIs
Publication statusPublished - Mar 2011

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Pain
Breakthrough Pain
Neoplasms
Opioid Analgesics
Therapeutics
Sleep
Psychology
Karnofsky Performance Status
Cancer Pain
Linear Models
Consensus
Cross-Sectional Studies
Regression Analysis
Neoplasm Metastasis
Research

Keywords

  • assessment
  • cancer
  • classification
  • pain
  • palliative care

Cite this

Knudsen, A. K., Brunelli, C., Kaasa, S., Apolone, G., Corli, O., Montanari, M., ... European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS) (2011). Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain. European Journal of Pain, 15(3), 320-327. https://doi.org/10.1016/j.ejpain.2010.08.001

Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain. / Knudsen, Anne Kari; Brunelli, Cinzia; Kaasa, Stein; Apolone, Giovanni; Corli, Oscar; Montanari, Mauro; Fainsinger, Robin; Aass, Nina; Fayers, Peter; Caraceni, Augusto; Klepstad, Pål; European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS).

In: European Journal of Pain, Vol. 15, No. 3, 03.2011, p. 320-327.

Research output: Contribution to journalArticle

Knudsen, AK, Brunelli, C, Kaasa, S, Apolone, G, Corli, O, Montanari, M, Fainsinger, R, Aass, N, Fayers, P, Caraceni, A, Klepstad, P & European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS) 2011, 'Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain', European Journal of Pain, vol. 15, no. 3, pp. 320-327. https://doi.org/10.1016/j.ejpain.2010.08.001
Knudsen, Anne Kari ; Brunelli, Cinzia ; Kaasa, Stein ; Apolone, Giovanni ; Corli, Oscar ; Montanari, Mauro ; Fainsinger, Robin ; Aass, Nina ; Fayers, Peter ; Caraceni, Augusto ; Klepstad, Pål ; European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS). / Which variables are associated with pain intensity and treatment response in advanced cancer patients? - Implications for a future classification system for cancer pain. In: European Journal of Pain. 2011 ; Vol. 15, No. 3. pp. 320-327.
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abstract = "BACKGROUND: This study is part of a research program to reach consensus on an international cancer pain classification system. A confirmative and explorative approach was applied to investigate which of the variables identified in the literature, by experts and patients that are associated with pain. METHODS: Data from an international, multicentre, cross-sectional study of cancer patients treated with opioids were investigated. Dependent variables were: average pain, worst pain, and pain relief (11-point Numerical Rating Scales). Forty-six independent variables were chosen based upon previous studies. Bivariate analyses identified independent variables associated with at least one of the dependent ones; 21 were included in multivariate linear regression analyses. RESULTS: Two thousand two hundred and seventy-eight patients were investigated; 52{\%} males, mean age 62years, mean Karnofsky Performance Status 59{\%}, mean daily opioid oral equivalent dose 341mg. Fifty-eight percent had breakthrough pain. Mean pain scores were: average pain 3.5, worst pain 5.3 and pain relief 74{\%}. Variables most strongly associated with these three dependent variables were: breakthrough pain, psychological distress, sleep, and opioid dose. CONCLUSIONS: Breakthrough pain and psychological distress were confirmed as key variables of a future classification system. Candidate variables were: sleep, opioid dose, pain mechanism, use of non-opioids, pain localisation, cancer diagnosis, location of metastases, and addiction.",
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note = "Acknowledgements This study was supported by the EU’s 6th framework, Contract No. 037777, the Norwegian Research Council, and partially funded by a grant from the Italian Association for Cancer Research (AIRC),IG 9347. Anne Kari Knudsen received a grant from the Central Nor-way Regional Health Authority.",
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AU - Apolone, Giovanni

AU - Corli, Oscar

AU - Montanari, Mauro

AU - Fainsinger, Robin

AU - Aass, Nina

AU - Fayers, Peter

AU - Caraceni, Augusto

AU - Klepstad, Pål

AU - European Palliative Care Research Collaborative (EPCRC) and the European Pharmacogenetic Study (EPOS)

N1 - Acknowledgements This study was supported by the EU’s 6th framework, Contract No. 037777, the Norwegian Research Council, and partially funded by a grant from the Italian Association for Cancer Research (AIRC),IG 9347. Anne Kari Knudsen received a grant from the Central Nor-way Regional Health Authority.

PY - 2011/3

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N2 - BACKGROUND: This study is part of a research program to reach consensus on an international cancer pain classification system. A confirmative and explorative approach was applied to investigate which of the variables identified in the literature, by experts and patients that are associated with pain. METHODS: Data from an international, multicentre, cross-sectional study of cancer patients treated with opioids were investigated. Dependent variables were: average pain, worst pain, and pain relief (11-point Numerical Rating Scales). Forty-six independent variables were chosen based upon previous studies. Bivariate analyses identified independent variables associated with at least one of the dependent ones; 21 were included in multivariate linear regression analyses. RESULTS: Two thousand two hundred and seventy-eight patients were investigated; 52% males, mean age 62years, mean Karnofsky Performance Status 59%, mean daily opioid oral equivalent dose 341mg. Fifty-eight percent had breakthrough pain. Mean pain scores were: average pain 3.5, worst pain 5.3 and pain relief 74%. Variables most strongly associated with these three dependent variables were: breakthrough pain, psychological distress, sleep, and opioid dose. CONCLUSIONS: Breakthrough pain and psychological distress were confirmed as key variables of a future classification system. Candidate variables were: sleep, opioid dose, pain mechanism, use of non-opioids, pain localisation, cancer diagnosis, location of metastases, and addiction.

AB - BACKGROUND: This study is part of a research program to reach consensus on an international cancer pain classification system. A confirmative and explorative approach was applied to investigate which of the variables identified in the literature, by experts and patients that are associated with pain. METHODS: Data from an international, multicentre, cross-sectional study of cancer patients treated with opioids were investigated. Dependent variables were: average pain, worst pain, and pain relief (11-point Numerical Rating Scales). Forty-six independent variables were chosen based upon previous studies. Bivariate analyses identified independent variables associated with at least one of the dependent ones; 21 were included in multivariate linear regression analyses. RESULTS: Two thousand two hundred and seventy-eight patients were investigated; 52% males, mean age 62years, mean Karnofsky Performance Status 59%, mean daily opioid oral equivalent dose 341mg. Fifty-eight percent had breakthrough pain. Mean pain scores were: average pain 3.5, worst pain 5.3 and pain relief 74%. Variables most strongly associated with these three dependent variables were: breakthrough pain, psychological distress, sleep, and opioid dose. CONCLUSIONS: Breakthrough pain and psychological distress were confirmed as key variables of a future classification system. Candidate variables were: sleep, opioid dose, pain mechanism, use of non-opioids, pain localisation, cancer diagnosis, location of metastases, and addiction.

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