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Population‐based study of the prevalence and management of self‐reported high pain scores in patients with non‐resected pancreatic adenocarcinoma

Tung S, Coburn NG, Davis LE, Mahar AL, Myrehaug S, Zhao H, Earle CC, Nathens A, Hallet J. Br J Surg. 2019; 106(12):1666-75. Epub 2019 Oct 22. DOI: 10.1002/bjs.11330.

Background — Pain is a common debilitating symptom in pancreatic adenocarcinoma. This cohort study examined the use of, and factors associated with, pain‐directed interventions for a high pain score in patients with non‐curable pancreatic adenocarcinoma.

Methods — Administrative databases were linked and patients with non‐resected pancreatic adenocarcinoma diagnosed between 2010 and 2016, who reported one or more Edmonton Symptom Assessment System (ESAS) score, were identified. A high pain score was defined as an ESAS score of at least 4. Outcomes were pain‐directed interventions: opiates (in patients aged 65 years or more with universal drug coverage), nerve block and radiation therapy for a high pain score. Reduction in pain score of at least 1 point after pain‐directed intervention was also evaluated. Modified Poisson regression was used to examine factors associated with pain‐directed intervention.

Results — Among 2623 patients with a median age of 67 years, 1223 (46·6 per cent) were women, and 1621 (61·8 per cent) reported a high pain score at a median of 38 days after diagnosis. Of those with a high pain score, 75·6 per cent (688 of 910) received opiates, 13·5 per cent (219 of 1621) radiation and 1·2 per cent (19 of 1621) nerve block. The pain score decreased in 62·1 per cent of patients after administration of opiates, 73·4 per cent after radiation and all patients after nerve block. In multivariable analysis, no patient factor (age, sex, co‐morbidity burden, rurality, income quintile) was associated with receipt of non‐opiate pain‐directed intervention for a high pain score. In patients aged at least 65 years, advanced age was associated with lower odds of opiate use.

Conclusion — Opiates are the most common pain‐directed intervention for non‐curable pancreatic adenocarcinoma, whereas radiation therapy and nerve blocks are seldom used. The lack of association between pain‐directed interventions and patient factors points toward practice‐driven patterns.