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Incidence and Management of Noncancer Pain in Cancer Patients Referred to a Radiotherapy Center

Massaccesi, Mariangela MD*; Deodato, Francesco MD*; Caravatta, Luciana MD*; Macchia, Gabriella MD*; Padula, Gilbert D.A. MD; Di Rito, Sonia Nurse*; Woldemariam, Aynalem A. MD; Rossi, Marco MD§; Di Falco, Carlo MD; Tambaro, Rosa MD; Mignogna, Samantha MD; Flocco, Mariano MD#; Pacelli, Fabio MD**; Valentini, Vincenzo MD††; Cellini, Numa MD††; Morganti, Alessio G. MD*,¶,††

doi: 10.1097/AJP.0b013e31827eb5e6
Original Articles

Objectives: The incidence of noncancer pain (NCP) in cancer patients is unknown. An analysis of incidence, severity, impact on quality of life (QoL), and appropriateness of NCP treatment in a cohort of cancer patients referred to a radiotherapy center is reported.

Materials and Methods: Pain was scored from 0 (absence) to 3 (severe) and the adequacy of analgesic therapy was evaluated according to International Guidelines. Correlation between Pain Management Index and World Health Organization Analgesic Ladder was used to analyze the appropriateness of NCP treatment. In addition, pain was differentiated according to its origin and types and a comparison was performed between cancer pain (CP) and NCP.

Results: A total of 903 patients were eligible and 865 (95.8%) were considered evaluable. Three hundred ninety-eight patients (46.0%) had pain. CP and NCP pain incidence was 11.2% and 34.8%, respectively. Pain intensity was higher in patients with CP versus NCP (P=0.021). A neuropathic pain lower incidence (P=0.024) in NCP versus CP was recorded. Moreover, NCP was more inadequately treated than CP (P<0.001). QoL was significantly lower in patients with NCP when compared with patients without pain (P<0.001). In addition, QoL of patients with CP was significantly lower than QoL of patients with NCP (P<0.001).

Discussion: In a cancer patients’ population referred to a radiotherapy center, the NCP incidence was higher than the CP incidence and NCP intensity was only slightly lower than CP. NCP was significantly pharmacologically undertreated and it was related to a decline in QoL.

*Radiation Oncology Unit, Department of Oncology

Palliative Therapy Unit, Department of Oncology

**Surgery Unit, Department of Oncology

§Department of Anesthesia, Intensive Care and Pain Medicine

Medical Direction; Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore, Campobasso

#Hospice Madre Teresa di Calcutta, Larino

††Department of Radiation Oncology, Università Cattolica del S. Cuore, Roma, Italy

Department of Radiation Oncology, The Lacks Cancer Center Saint Mary’s Health Care, Grand Rapids, MI

Department of Radiation Oncology, Black Lion Hospital, Addis-Ababa, Ethiopia

The authors declare no conflict of interest.

Reprints: Gabriella Macchia, MD, Radiation Oncology Unit, Department of Oncology, Università Cattolica del S. Cuore, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Campobasso, Largo A. Gemelli 1, Campobasso 86100, Italy (e-mail:

Received March 29, 2012

Accepted November 18, 2012

© 2013 by Lippincott Williams & Wilkins