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Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

Authors
Journal
Radiotherapy and Oncology
0167-8140
Publisher
Elsevier
Publication Date
Volume
75
Issue
1
Identifiers
DOI: 10.1016/j.radonc.2004.12.016
Keywords
  • Bone Metastases
  • Pain Flare
  • Radiotherapy
  • Meaningful Change
Disciplines
  • Medicine

Abstract

Abstract Background and purpose To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0–10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0–10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials.

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