Prevalence of acute pain crisis in patients with cancer in Specialist Palliative Care Clinic: An observational study

TL;DR

This study found that 1.7% of cancer patients visiting a palliative care clinic in India experienced acute pain crises, highlighting the need for timely and effective pain management in such settings.

Contribution

This is the first study to evaluate the prevalence of acute pain crisis in an outpatient specialist palliative care clinic.

Findings

The prevalence of acute pain crisis was 1.7% among eligible cancer patients.

Intravenous fentanyl was most commonly used, with significant pain score reductions within 30 minutes.

Radiating and shooting pain were the most frequently reported pain qualities.

Abstract

To evaluate the prevalence of acute pain crisis among cancer patients presenting to an outpatient specialist palliative care clinic.

This observational study was conducted over six months at a tertiary cancer hospital in India utilizing the ESAS-r and Distress Thermometer tools. Eligible participants were patients aged 18 years or older who attended the Palliative Medicine outpatient clinic with a pain score of 7 or above on the Numerical Rating Scale and a distress score of 4 or higher on the Distress Thermometer.

Of the 5,570 patients screened for eligibility, 95 presented with an acute pain crisis, yielding a prevalence of 1.7% (95% CI: 1.38–2.08). The median age of the patients was 50 years (IQR: 40–57), with 54% females and 46% males. The most common cancer sites were the head and neck (20%), followed by gynecological (13.7%), and thoracic/breast/hepatobiliary (10.5%) cancers.

The most frequent pain quality descriptors were radiating pain (59%), shooting (49%), electrical or throbbing (44%), pricking (43%), dull aching (38%), burning (27%), tenderness (20%), cramping (17%), and unknown types (2%). The median distress score reported on the Distress Thermometer was 8 (IQR: 6–9).

Intravenous fentanyl was the most commonly used analgesic for managing pain crisis, with a median dose of 20 mcg (IQR: 20). The median NRS pain scores were 9 (IQR: 8–10) at 0 minutes, 6 (IQR: 4–7) at 15 minutes, and 3 (IQR: 2–4) at 30 minutes. The reductions in NRS scores at 15 and 30 minutes were 3 and 6 points, respectively.

To the best of our knowledge, this is the first study aimed at evaluating the prevalence of pain crisis in an outpatient specialist palliative care clinic. Managing an acute pain crisis in such a setting requires a careful balance of timely interventions, appropriate medication use, and strong communication among patients, caregivers, and palliative care physicians. The causes of acute pain crisis were not explored in this study, which represents a potential area for future research.

Clinical Trials Registry India (CTRI) Reg no. CTRI/2024/02/062517 [Registered on 12/02/2024].

Figures