Sherbak Anna Belarusian State Medical University, Minsk, Belarus EFFICIENCY TREATMENT OF CHRONIC PAIN SYNDROME IN CANCER PATIENTS IV CLINICAL GROUP

1. EFFICIENCY TREATMENT OF
CHRONIC PAIN SYNDROME IN
CANCER PATIENTS IV
CLINICAL GROUP
Rapporteur Sherbak Anna
Belarusian State Medical University, Minsk, Belarus
Supervisor of PhD Papok V.E.

2. Aim of work
 examine the incidence of chronic pain (CPS)
depending from the primary tumor site
 causes of CPS
 estimate the effectiveness of treatment in
cancer patients CPS IV clinical group

3. The urgency of the problem
 According toWHO statistics, 6 million cases of
cancer, 5.5 million suffer from pain.
 In Belarus, 40,000 patients with newly diagnosed
malignant process (about 9000 patients in
Minsk).
 Of these, 13.5% is in stage III-IV disease and 25%
of patients die within the first year after
diagnosis.
 Thus each year nearly 20,000 cancer patients
suffer from pain

4. Materials and methods(1)
 The studies were performed in 60 cancer
patients with chronic pain (32 women and 28
men) aged 46 - 89 years. All patients were in the
hospital 'Hospital palliative care "Hospice".
26, 43%
19, 32%
15, 25%
The age structure of patients
61-75 years
(advanced age)
46-60 years
(adulthood)
76-89 years
(senium)

5. Materials and methods(2)
 Hospital record
 McGill Pain Questionnaire
 10-point visual analogue scale (VAS)
 Verbal pain scale (VPS).
 Physical activity scale (PAS)
 Side effects of drugs

6. The distribution of patients
depending on the location of the
primary tumor
23, 38%
10, 17%
8, 13%
4, 7%
4, 7%
3, 5%
2, 3% 6, 10%
Digestive organs
Breathing system
Mammary gland
Prostate
Pancreas
Organs ot the
urinary system
CUP
Other localization

7. The distribution of patients
depending on the type of pain
37, 63%
14, 24%
5, 8% 3, 5%
Visceral pain
Somatic pain
Mixed pain
Neuropathic pain

8. The distribution of patients
depending on the causes of pain
Cause of pain The number of
patients
The proportion of
patients (%)
The pain caused by
a neoplastic
process
49 82
The pain caused by
complications of
tumor
8 13
The pain is caused
by anti-tumor
therapy
3 5

9. Patients with CPS associated
with neoplastic process
 The pain is associated with a primary tumor - 15 patients
(30.6%)
 The pain associated with metastatic disease - 34 patients
(56.6%)
11, 32%
9, 26%
8, 24%
3, 9%
3, 9%
Bones
Hepar
Lungs
Brain
Other localization

10. Characteristics of patient
groups
A group of
patients
Number of
patients
The pain
intensity on
theVAS
The nature
of pain
(VPS)
Drugs
Group I 33 3 - 5 Moderate
pain
Ketorolac
Group II 17 5 - 8 Severe pain Tramadol
Group III 10 8 - 10 Horrible pain Promedol

11. The condition of patients
before and after treatment
A group of
patients
VAS
before
treatment
VAS after
treatment*
PAS before
treatment
PAS after
treatment
Side
effects
(%)
Group I
(VAS=3 – 5)
4,1 ± 0,82 2,3 ± 0,64 2,6 ± 0,49 2,1 ± 0,17 4 (12%)
Group II
(VAS=5-8)
6,2 ± 0,41 2,8 ±0,79 3,4 ± 0,61 2,3 ± 0,96 6 (35 %)
Group III
(VAS=8-10)
8,3 ± 0,46 3,2 ± 1,14 3,6 ± 0,49 2,1 ± 0,61 2 ( 20 %)
The changes are significant at p <0,0001

12. The effectiveness of
treatment in each group CBS
31;94%
13;76%
9;90%
2;6%
4;23%
1;10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group I Group II Group III
Effective therapy no effective therapy

13. The incidence of side
effects
29;88%
11;65%
8;80%
4;12%
6;35%
2;20%
0
5
10
15
20
25
30
35
Group I Group II Group III
No side effects Side effects of

14. The effectiveness of
tramadol
 The group II of the most high indicators of the
inefficiency (4;23%) and the emergence of
side-effects (6;35%)
 MeanVAS before treatment in this group of
patients whose treatment was ineffective
was 6,75 ± 0,43

15. The results and conclusions (1)
 CPS in patients with cancer is more common in
the localization of the primary tumor in the
organs of the gastrointestinal tract, the
respiratory tract and mammary gland
 The emergence of CPS in patients with cancer is
more often associated neoplastic process
itself, especially with the presence of metastases
 The most severe pain syndrome seen in patients
with brain metastases and metastatic having
lytic activity in the bone

16. The results and conclusions (2)
 The use of ketorolac in patients with
moderate pain and promedol in patients with
intolerable pain is an effective
 The results of use of tramadol in patients with
strong pain differ, so patients with CPS 5-7
points on theVAS application is effective, and
in patients with a ≥ 7 points CPS is inefficient
and requires the use of drugs.

17. Thank you for your attention!