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Verbal Descriptors of Cancer Induced Bone Pain (CIBP)

Verbal Descriptors of Cancer Induced Bone Pain (CIBP). Anne Todd Palliative Care Research Nurse University of Edinburgh. Acknowledgements. Professor Marie Fallon Professor Lorraine Smith Dr Barry Laird Dr Angela Scott Dr John Walley Gillian McHugh. Outline. Cancer Pain

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Verbal Descriptors of Cancer Induced Bone Pain (CIBP)

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  1. Verbal Descriptors of Cancer Induced Bone Pain (CIBP) Anne Todd Palliative Care Research Nurse University of Edinburgh

  2. Acknowledgements • Professor Marie Fallon • Professor Lorraine Smith • Dr Barry Laird • Dr Angela Scott • Dr John Walley • Gillian McHugh

  3. Outline Cancer Pain Background: CIBP Methods Results- preliminary findings Summary

  4. Background

  5. Cancer Pain - Problem? • Approximately 7.4 million people die from cancer in each year (WHO 2009) 1 • Uncontrolled cancer pain is associated with  depression, anxiety, hostility, distress 2 • Exacerbates other symptoms associated with cancer 2 • The majority of difficult to control cancer pain is either CIBP or Neuropathic cancer pain 2 1 World Health Organization (WHO) (2009) Cancer: Fact sheet No. 297. Last accessed 22/06/2010 available at www.who.it/mediacentre/factsheets/fs297/en/index.html 2 Mercadante, S., Ma;ignant bone pain: pathophysiology and treatment. Pain, 1997. 60(1-2) pp 1-19

  6. Cancer Induced Bone Pain (C.I.B.P.) • Common • Metastatic cancer invades bone in approx. 60-84% of cases1 • Correlates with an increased morbidity 2 • Reduced performance status 3 • Increased anxiety and depression 3 • Reduced quality of life 4 • 1 Mercadante, S., Ma;ignant bone pain: pathophysiology and treatment. Pain, 1997. 60(1-2) pp 1-19 2 Coleman, R.E., Cancer 1997;80 pp 1588-94 3 Portenoy, Payne, Jacobsen Pain 1999;81:129-34 4Mercadante, Arcuri Cancer Treat Res 1999;29:1001-29

  7. CIBP CIBP is one of the commonest types of cancer pain CIBP is typically very difficult to manage CIBP therapies are specific to the pain syndrome Appropriate identification of the underlying pain syndrome allows appropriate treatment to be initiated TO DATE ACCURATE IDENTIFICATION OF CERTAIN PAIN SYNDROMES IS CHALLENGING

  8. Aim The aim of this study was to characterize the verbal descriptors of CIBP in a cross-section of patients with pain from bone metastases

  9. Methods

  10. Study Design A cross sectional prospective survey of patients with CIBP attending the study centre Ethical approval Patients under oncology care -Edinburgh Cancer Centre Convenience sample Patients – IP and OP

  11. Study Overview Secondary analysis of data from clinical trials examining CIBP: • Development of a systematic approach to assess the sensory, cognitive, affective and functional components of cancer induced bone pain • Characterisation of the physical properties of pain caused by bone malignancy and comparison with the physical properties of neuropathic pain

  12. Inclusion Criteria • CIBP as per recognised criteria • Symptomatic in the preceding 24 hours. • Only eligible if their index pain site was regarded by them, to be their most problematic pain. • 18 years of age or over Exclusion Criteria • Felt to be in the last week of their lives • Unlikely to be able to complete the study protocol due to their clinical condition • Origin of their pain was unclear

  13. Data Analysis • Database designed • Common data from all studies entered • Demographics • Pain assessed – index site –previous 24hrs • Questionnaires: • Brief Pain Inventory (BPI) • McGill Pain Questionnaire (MPQ)

  14. McGill Pain Questionnaire (MPQ) Validated in the assessment of cancer pain and is utilised to elicit information pain locality, intensity and behaviour 1 The MPQ developed to allow patients to identify pain from a list of 78 words. These words included throbbing, shooting, hot-burning or sharp.2 1. Towery SMA, Fernandez, E.: Reclassification and Rescaling of McGill Pain Questionnaire Verbal Descriptors of Pain Sensation: A Replication. Clinical Journal of Pain. 12:270-276, 1996 2. Melzack R: The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1:277-299, 1975

  15. MPQ

  16. Statistical Analysis • Patient demographics and pain characteristics were summarised using proportions, and means and standard deviations (SDs) or medians and inter-quartile ranges (IQRs)

  17. Results Preliminary findings

  18. Brief Pain Inventory Box and whisker plot representing the median value, with 50% of the data falling within the box [Interquartile range]. The whiskers extend to the 5th and 95th percentiles.

  19. Words most commonly chosen (MPQ) WordFrequency Aching 60 (50%) Gnawing 51 (42.5%) Throbbing 44 (36.7%) Sharp 39 (32.5%) Tender 37 (30.8%) Shooting 36 (30%)

  20. Neuropathic features of CIBPKerba et al (2010)Neuropathic Pain Features in Patients With Bone Metastases Referred for Palliative Radiotherapy, JCO • Prospective cross-sectional survey of ninety eight consecutive patients referred for palliative radiotherapy for metastatic bone pain • Data was gathered on demographics, analgesia and other pain treatments. Assessments included BPI, S-LANNS (Self-report Leeds Assessment of Neuropathic Symptoms and Signs) and the EORTC (European Organisation for Research and Treatment of Cancer) Quality of Life Questionnaire (version 3) at baseline and 4-6 weeks later. • Results: median age 62 years, Equal gender distribution (male n=51, female n=47) cancer sites; breast (34%), prostate (28%), non-small cell lung cancer (11%). • 17% of patients with bone pain had neuropathic features in their pain (S-LANSS of ≥ 12, criteria indicative of neuropathic pain)

  21. BONE NEUROPATHIC Sharp Tender Shooting Aching Gnawing Throbbing Cramping Pins and needles

  22. Summary • Systematic characterisation of verbal descriptors of cancer induced bone pain • Initial findings are very encouraging and would suggest that certain words are suggestive of CIBP • However there may be an overlap with other pain descriptors • At the end of the day – it’s only words!

  23. Thank you anne.todd@ed.ac.uk

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