PAIN EXPERIENCED BY PATIENTS WITH TERMINAL HEAD AND NECK-CARCINOMA

BACKGROUND. Pain is one of the most feared consequences of cancer and is experienced by up to 80% of patients with head and neck carcinoma ( HNC). Pain in terminal HNC patients is common and often defined as sev ere. This study evaluated the effectiveness of the World Health Organi zation (WHO) analgesic ladder in the treatment of a cohort of terminal HNC patients. METHODS. The authors prospectively evaluated 62 consecu tive terminal HNC patients admitted to the Chaim Sheba Medical Center Tel Hashomer Hospice or the general hospital. Data pertaining to tumor origin, spread, treatment, and results were defined. Pain was assesse d with the McGill Pain Questionnaire, using a 10-point visual analogue scale (VAS) and a body map. Pain was diagnosed according to cause and type. Treatment was selected according to the guidelines provided in the WHO analgesic ladder. RESULTS. Only 10 patients suffered from pain that was not locoregional. The results of the VAS score were availabl e in the first reading in all patients with pain (n = 48), with a mean of 4.7 (standard deviation [SD] +/- 2.0). A mean second VAS score obt ained 72 hours after the first was 1.9 (SD +/- 1.1). The difference be tween the two scores was statistically significant (P < 0.001). A thir d score was available for only 6 patients, with a mean of 1.6. Only 2 patients did not experience improvement of pain after 72 hours of trea tment; both of these patients had bony involvement with tumor. Thirty- one patients (65%) were diagnosed with pain of nociceptive origin; the se patients were categorized as having actual nociceptive pain (22), n ociceptive nerve pain (6), or referred pain to the ear (3). Nonnocicep tive pain of neuropathic origin was noted for only 6 patients (12.5%). Pain that could not be well defined but was responsive to opioid anal gesic treatment was noted for 11 patients. A different form of non-can cer-related pain was noted for only one patient. CONCLUSIONS. Patients were treated for pain according to the WHO analgesic ladder. They rec eived adequate narcotic analgesics and supportive measures that allowe d significant reduction of pain in nearly all cases, with acceptable s ide effects. (C) 1997 American Cancer Society.