Cancer-Related Bone Pain: Patients’ Satisfaction with Analgesic Pain Control
Andrew Tabu Kaggwa1, Protus Werunga Kituyi1,2, Elijah Nzeki Muteti 1,3, Ramadhani Barry Ayumba 1,3
1 School of Medicine, Moi University, Eldoret, Kenya
2 Department of Surgery and Anesthesiology, Moi University, Eldoret, Kenya
3 Department of Orthopedics and Rehabilitation Medicine, Moi University, Eldoret, Kenya
Correspondence to: Andrew Tabu Kaggwa; email:firstname.lastname@example.org
Received: 29 April 2022; Revised: 06 Jun 2022; Accepted: 15 Jun 2022; Available online: 27 Jun 2022
Background: Management of cancer-related bone pain (CRBP) with analgesics poses a substantial challenge. This study aimed to determine the correlation between pain control satisfaction and prescribed analgesics. Methods: This 12-month descriptive prospective study included 96 adults who were consecutively sampled and followed up daily for 5 days. Eligible patients had histopathologically confirmed tumor, osseous lesion(s) on radiographs, and cognitive capacity to rank pain on the Numerical Rating Scale. Data were collected using questionnaires drafted from the Brief Pain Inventory. Self-assessed pain scores within the past 24 hours were reported on a scale of 0 (no pain) to 10 (worst pain). Pain control satisfaction was assessed as a single response question (satisfied, not sure, or dissatisfied). Associations were examined in multiple logistic regression models. Ethical approval and informed consent were obtained. Results: The median age was 57 (range, 19–90) years, and more males (52.1%) than females were recruited. The proportion of CRBP ranged from 83.3% to 86.5%, whereas that of moderate to severe pain ranged from 57.3% to 69.8%. Overall, 70.8% were satisfied with their pain control. Patients prescribed opioids (adjusted odds ratio, 0.027; p=0.041) had an increased likelihood of pain control satisfaction. Conclusion: Although a high percentage of patients experienced moderate to severe CRBP, a majority were satisfied with their analgesic pain control. Prescription opioids were associated with higher satisfaction. Policies that sustain ready accessibility of analgesics, particularly opioids, should be implemented.
Keywords: Analgesics, Bone cancer pain, Satisfaction, Treatment outcomes
Ann Afr Surg. 2022; 19(3): 144-152
Bone malignancies include primary bone tumors that start in the bone as well as metastatic bone tumors, which occur when cancer infiltrates the bone. They are usually associated with numerous skeletal-related events (SREs), including bone pain, pathological fractures, spinal cord compression, and hypercalcemia. Bone malignancies are the most common causes of pain associated with cancer (1-3). Cancer-related bone pain (CRBP) is prevalent in 85% of advanced breast, prostate, lung, and kidney cancer patients (1,2), and its management with analgesics poses a substantial orthopedic challenge. If not adequately managed, it would adversely reduce the patients’ quality of life (2,4).
Quantifying CRBP in absolute terms remains challenging in clinical practice because most data tools focus only on pain’s physical or sensory aspects. The assessment of physical pain is subjective, but it is the most effective method of quantifying pain intensity, given that it is not proportional or related to the severity of the underlying pathology. Pain is only influenced by the patient’s perception of it (5,6). It goes without saying that CRBP, like any other kind of cancer pain, is frequently accompanied by psychosocial symptoms, i.e., depression, stress, anxiety, etc., that could considerably impair a patient’s quality of life. However, this study does not examine the emotional or psychosocial component of CRBP.
Up to 90% of patients with bone malignancies are estimated to have varying degrees of CRBP (1,7), and its severity is usually moderate to severe (1). However, patients often receive suboptimal analgesic pain management despite the knowledge that pain is an essential determinant of cancer patients’ quality of life (2,4).The role of analgesics remains crucial in controlling CRBP (1,8,9), as they provide over 80% cancer pain relief if used effectively (10). Potent opioids are still the recommended first-line analgesics in managing moderate to severe CRBP (2). However, underutilization or prescription of opioids is a burden in the Sub-Sahara, where only less than 1% of the global morphine is consumed (11). The low morphine consumption has been significantly attributed to shortages of analgesics, especially opioids, under-prescription, inappropriate pain assessment, underutilization of guidelines, and misconceptions on their use (11). Analgesics must therefore be prescribed appropriately and administered as directed. The World Health Organization (WHO) analgesic ladder remains the widely acknowledged standard in cancer pain treatment, assisting clinicians in clinical decision-making when selecting the potent analgesics. Appropriate cancer pain assessment using validated tools is thus crucial, as analgesic steps are recommended based on pain intensity.
A primary survey conducted at Moi Teaching and Referral Hospital by the principal researcher revealed that a sizable proportion of bone malignancy patients complained of some degree of pain despite being on different specific analgesics meant to control pain. It was, however, unclear whether patients were satisfied with their analgesic pain control. It was also impossible to gauge satisfaction outcomes and the management of CRBP with analgesics at MTRH with the rest of the world. The regional void of information on CRBP and satisfaction as a treatment outcome necessitated the need for this study. It is justifiable that this study will provide baseline data to help inform the development and strengthening of CRBP management protocols at the facility. It will also offer baseline data for future related research.
On further literature review, it was not clearly understood whether prescribed analgesics influence satisfaction with CRBP control. The concept that satisfaction with pain control is a vital indicator of analgesic effectiveness in CRBP treatment outcomes may suggest such a correlation. Conflicting information exists regarding the correlates of patients’ pain control satisfaction. The amount of pain relief obtained by a patient (12), aspects of the patient-provider interaction, pain intensity, age, beliefs, and anxiety at treatment onset are predictive of satisfaction with pain control (13-17). Locally, no study that assessed patients’ satisfaction with pain control based on the extent and nature of CRBP was found. This study also aimed to determine the relationship between satisfaction with pain control and prescribed analgesics in order to lend credibility or justify CRBP management protocol with analgesics as well as to ascertain whether pain management is satisfactory to the patient.
Study designs and settings
This descriptive prospective study was conducted at Moi Teaching and Referral Hospital in Eldoret town in western Kenya from March 2019 to March 2020. At least 600 cases of cancer are diagnosed at the hospital annually. In western Kenya, it serves as the most prominent cancer treatment center. The study was conducted in the hospital’s wards and out-patients’ clinics. Informed written conse