Pain Management Watch

Pain Level Can Be a Predictor of Cancer Survival

When head and neck cancer patients were assessed for pain level, investigators found differences in survival rates for those patients reporting low posttreatment pain versus those with high pain. For the study, University of Iowa researchers followed 339 head and neck cancer patients who provided information about their health and quality of life at 4 stages: at diagnosis, and 3, 6, and 9 months later. Patients also rated their posttreatment pain.

The researchers found that the 5-year survival was 81.8% for patients with low posttreatment pain and 65.1% for those with high pain. They also found an association between pain and age, physical and mental health conditions, depressive symptoms, survival rate, and recurrence within the first year.

The study appears in the August issue of Archives of Otolaryngology.

FAST FACT: The most commonly reported food triggers for migraine are alcohol (33%) and chocolate (22%).

Letting Pain Patients Tell Their Story

Attendees at last spring’s annual meeting of the American Pain Society heard remarks from an unlikely source—University of Virginia English professor David Morris, PhD. Morris urged his audience of pain management specialists to engage in more dialogue with their patients to improve treatment outcomes.

“With every patient there is a story, and practicing narrative medicine allows patients to expose their beliefs about their condition that might create barriers to effective treatment,” he said.

Morris explained that dialoguing with patients replaces one form of patient narrative—“catastrophizing,” in which patients feel anxious, fearful, and hopeless about their pain—with another narrative, focused on coping and functioning better. He said that “clinicians with strong narrative abilities can help reduce patients’ fear, lower perceived pain intensity, and improve overall quality of life.”

New Guideline for Low Back Pain

The American Pain Society (APS) has a new clinical practice guideline for low back pain emphasizing the use of noninvasive treatments over surgery. The new APS guideline provides clinicians with 8 recommendations to help determine the best way to treat patients with low back pain, with an emphasis on shared decision-making between provider and patient and a frank discussion of the risks and benefits of surgical interventions.

Low back pain is the fifth most common reason for doctor visits and accounts for $26 billion in direct health care costs nationwide each year. The APS guideline recommends against vertebral disc replacement in patients with nonradicular low back pain or common degenerative spinal changes; it also advises a risk—benefit discussion of epidural steroid injections.

To develop the new guideline, a multidisciplinary APS panel, along with experts on interventional therapies, reviewed 3348 abstracts and analyzed 161 relevant clinical trials. The bottom line, say researchers, is that noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery. The guideline was published in the journal Spine (May 1, 2009).

Bedside Test Diagnoses Chronic Back Pain

Researchers at Massachusetts General Hospital have developed a simple and inexpensive method of assessing pain using a Standardized Evaluation of Pain (StEP)—a set of 6 questions and 10 physical tests. Experts say that being able to determine more precisely the underlying nature of pain is essential to choosing the best treatment.

“Currently clinicians measure pain only by asking how bad it is, using scales from mild to moderate to severe, or asking patients to rate their pain from 1 to 10,” said the study’s lead author Joachim Scholz, MD. “This approach misses key characteristics that reflect the mechanisms causing the pain.”

To test the validity of StEP, investigators collaborated with researchers from a UK teaching hospital, who enrolled 137 patients with chronic low back pain. To determine whether their pain was neuropathic, patients were evaluated by an interdisciplinary team of 2 physicians and a physical therapist. Participants then received the StEP assessment from an investigator not informed of the results of the clinical evaluation. The StEP was able to accurately determine whether a participant’s back pain was neuropathic. The research, “A Novel Tool for the Assessment of Pain: Validation in Low Back Pain,” appears in PLoS Med.