Neuropathic Pain Features in Patients with Bone Metastases
Neuropathic Pain Features in Patients with Bone Metastases
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DOI：
10.1016/j.clon.2015.10.007
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发表时间：
2016-03-01
影响因子：
3.4
通讯作者：
Akimoto, T.
中科院分区：
文献类型：
--
作者：
Nakamura, N.;Takahashi, O.;Akimoto, T.
目的：先前随机对照试验的结果表明，放射肿瘤学家在为疼痛的骨转移瘤开出分次剂量时，应考虑神经病理性疼痛的存在。尽管目前已有经过验证的神经病理性疼痛特征筛查工具，但此类特征在骨转移疼痛患者中的流行情况仍鲜为人知。本研究的目的是评估因骨转移疼痛而接受姑息放射治疗的患者中神经病理性疼痛特征的患病率。材料和方法：我们对2013-2014年间在圣卢克国际医院接受姑息放射治疗的连续骨转移癌患者进行了队列调查。在放射治疗前，使用有效的筛查问卷对患者进行前瞻性评估，以确定日本患者的神经病理性疼痛成分。采用7项问卷的总分和分界值<gt；=9，前瞻性定义具有神经病理性特征的疼痛。放疗开始2个月后，根据国际骨转移瘤共识工作组定义的标准对疼痛反应进行评估。24%的患者(95%可信区间：16%-35%)被诊断为具有神经病变特征的疼痛。在多变量分析中，神经病理性疼痛特征和患者特征之间没有明显的相关性。64名患者(74%)在放疗开始后2个月可进行评估。有神经性特征的患者总有效率为59%(95%可信区间：33-82%)，无神经性特征的患者总有效率为55%(95%可信区间：40-70%)。结论：相当比例的患者被证实存在神经病理性骨痛。有必要进行进一步的研究，结合疼痛分布和影像发现来验证症状评估工具，并澄清神经病理性疼痛的存在是否影响姑息性放射治疗的反应。(C)2015年皇家放射科医师学会。爱思唯尔有限公司出版。保留所有权利。
Aims: The results of previous randomised controlled trials suggest that radiation oncologists should consider the presence of neuropathic pain when they prescribe dose fractionations for painful bone metastases. Although validated screening tools for neuropathic pain features are currently available, the prevalence of such features among patients with painful bone metastases is still poorly understood. The purpose of this study was to estimate the prevalence of neuropathic pain features among patients who received palliative radiotherapy for painful bone metastases.Materials and methods: We conducted a cohort survey of consecutive patients who received palliative radiotherapy for painful bone metastases at St Luke's International Hospital between 2013 and 2014. Patients were prospectively assessed before radiotherapy using the validated screening questionnaire to identify neuropathic pain components in Japanese patients. Pain with neuropathic features was prospectively defined using the total score of the seven-item questionnaire and a cut-off score >= 9. The pain response was assessed 2 months after the start of radiotherapy according to the criteria defined by the International Bone Metastases Consensus Working Party.Results: Eighty-seven patients were assessed. Twenty-four per cent of patients (95% confidence interval: 16-35%) were diagnosed as having pain with neuropathic features. On multivariate analysis, no significant correlations were seen between neuropathic pain features and patient characteristics. Sixty-four patients (74%) were assessable 2 months after the start of radiotherapy. Overall response rates were 59% (95% confidence interval: 33-82%) in patients with neuropathic features and 55% (95% confidence interval: 40-70%) in those without such features.Conclusions: A considerable proportion of the patients were proven to have bone pain with neuropathic features. Further investigations are warranted to validate symptom assessment tools in cooperation with pain distribution and image findings, and to clarify if the presence of neuropathic pain affects the response to palliative radiotherapy. (C) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.