Effect of the presence of metastasis on the treatment of pain in patients with cancer pain: A retrospective study

Cancer pain leads to cancer pain syndromes through nociceptive or neuropathic mechanisms. In patients with metastasis, an increase of the amount of the involvement regions leads to common pain syndrome and also an increase in the severity of pain.In our study, we conducted a retrospective evaluation of pain treatment methods applied, and investigated the effect of the presence of metastasis in oncology patients who were followed up for cancer-related pain between January 1997 and December 2010 at the Algology Department in Firat University Faculty of Medicine.There were 1736 patients had been treated and followed up, 269 of thispatients excluded because they had not have enough data, total 1467 patient included this study. Patients were divided into three groups as follows: patients without metastasis (Group I) (n: 605), patients with single metastases (Group II) (n: 576) and patients with multiple organ metastases (Group III) (n: 286)There was no difference between the ages of the patients. Admission VAS scores were higher in group III (8.0245 ± 0.03) than other groups, and higher in group II (7.7639 ± 0.04) compared to group I (6.0959 ± 0.03).For the treatment of the pain, TAD, corticosteroid, anticonvulsants, neuroleptics, benzodiazepines, LA, bisphosphonates and calcitonin were used at the rates of 61.0% (895 patients), 7.1% (104 patients) 4.0% (58 patients), 4.0% (58 patients), 1.6% (23 patients), 12.3% (180 patients), 1.2% (17 patients) and 2.8% (41 patients).A total of 85.5% (1255 patients) of the patients were treated with WHO analgesic ladder treatment, and 14.5% (212 patients) of the patients were treated with additional MIAPs. The treatment rate in steps I and II was lower in group II and group III compared to group I, and in step III treatment rate was higher in group II and group III compared to group I. Rate of the use of MIAPs was higher in group III than the other groups, and this rate was also higher in group II than group I.In conclusion, the presence of metastasis increases the intensity of the pain in patients with cancer pain. The severity of the pain makes the pain treatment difficult in cancer patients. Thus, we think that the presence of metastases necessitates an increase in the analgesia stage and consumption of opioids in patients with cancer pain.Keywords: Cancer pain, metastasis, opioid, analgesic, minimally invasive analgesic procedure, adjuvants.