Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea.
Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
PLoS One. 2021 Aug 17;16(8):e0252781. doi: 10.1371/journal.pone.0252781. eCollection 2021.
Evaluation of symptoms and signs for the management of neuropathic cancer pain (NCP) is challenging. This study aimed to identify clinical predictors of NCP and symptoms and signs most relevant of those in Korean patients.
This nationwide, descriptive, cross-sectional, multicenter, observational study included 2,003 cancer patients aged ≥20 years who reported a visual analog scale (VAS) score ≥1 for pain and provided informed consent for participation. The Douleur Neuropathic (DN4) questionnaire (score ≥4) was used to determine symptoms and signs as well as the presence of NCP.
The prevalence of NCP was associated with age <65 years [OR, 1.57; 95% CI, 1.270-1.934], disease duration >6 months (OR, 1.57; 95% CI, 1.232-2.012), stage IV cancer (OR, 0.75; 95% CI, 0.593-0.955), history of chemotherapy (OR, 1.74; 95% CI, 1.225-2.472), and moderate-to-severe cancer pain (OR, 2.05; 95% CI, 1.671-2.524) after multivariate analysis. The most common descriptive symptoms of NCP were tingling, electric shock, and pins and needles. For NCP patients in the presence or absence of the clinical predictors, pins and needles (p = 0.001) and painful cold (p<0.001) symptoms were significantly frequent in patients with moderate-to-severe pain. Tingling, numbness, and touch hypoesthesia (p = 0.022, 0.033, 0.024, respectively) were more frequent in those with longer cancer duration and hyperesthesia (p = 0.024) was more frequent in young patients.
Age <65 years, disease duration >6 months, stage IV cancer, history of chemotherapy, and moderate-to-severe cancer pain, were identified as predictors of NCP. Some symptoms and signs of NCP were associated with these predictors. Further studies are warranted on the pathogenesis and management of NCP with respect to the symptoms and signs, and factors associated with pain severity in Korean patients.
神经病理性癌痛（NCP）的症状和体征评估具有挑战性。本研究旨在确定 NCP 的临床预测因素以及韩国患者中最相关的症状和体征。
这是一项全国性、描述性、横断面、多中心、观察性研究，纳入了 2003 名年龄≥20 岁的癌症患者，这些患者报告疼痛视觉模拟量表（VAS）评分≥1，并同意参与研究。使用 Douleur Neuropathique（DN4）问卷（评分≥4）来确定症状和体征以及 NCP 的存在。
NCP 的患病率与年龄<65 岁（OR，1.57；95%CI，1.270-1.934）、疾病持续时间>6 个月（OR，1.57；95%CI，1.232-2.012）、IV 期癌症（OR，0.75；95%CI，0.593-0.955）、化疗史（OR，1.74；95%CI，1.225-2.472）和中重度癌症疼痛（OR，2.05；95%CI，1.671-2.524）相关。多变量分析后，NCP 的最常见描述性症状为刺痛、电击和麻木感。对于存在或不存在临床预测因素的 NCP 患者，中重度疼痛患者的麻木感（p=0.001）和冷痛（p<0.001）症状明显更频繁。较长的癌症持续时间和感觉过敏与刺痛（p=0.022、0.033、0.024）、麻木感（p=0.022、0.033、0.024）和触觉感觉减退（p=0.022、0.033、0.024）相关，而年轻患者更常出现感觉过敏（p=0.024）。
年龄<65 岁、疾病持续时间>6 个月、IV 期癌症、化疗史和中重度癌症疼痛被确定为 NCP 的预测因素。NCP 的一些症状和体征与这些预测因素相关。有必要进一步研究韩国患者的 NCP 发病机制和管理，以及与疼痛严重程度相关的症状和体征及因素。
