| Abstract |
Background: Neuropathic pain, which is a symptom and not a disease, is caused by a lesion or
disease of the somatosensory system. There are two types of neuropathic pain, depending on the
topography of the lesion, the central and the peripheral. It is estimated that it affects 7-10% of the
global population and it is more common in people over the age of 50. It usually coexists with
other types of pain, like nociceptive pain, and these cases are called mixed syndromes. Patients
with neuropathic pain deal with sleep disorders, anxiety, depression and therefore the quality of
their life is affected.
Objective: The purpose of this master’s thesis is the retrospective study of cases with neuropathic
pain and the comparison of patients with malignancy and non-malignancy, in terms of causes,
treatment and final outcome.
Methods: This is a retrospective and monocentric study, which took place at the Pain Centre of
the Anesthesiology Clinic of the University General Hospital of Heraklion. The patients’ medical
records were studied for the data collection and the data registration was made in an electronic
database. The presence of neuropathic pain was defined as the inclusion criterion. The total sample
consisted of 120 patients, 60 of whom had a malignancy and the remaining 60 did not. Pain was
assessed using the Visual Analog Scale-VAS.
Results: The mean age of patients was 64.0±15,1 years. Pain was classified into neuropathic pain
(52, 43.3%) and mixed pain (68, 58.7%). The most common causes of pain for non-malignancy
cases were Herpes Zoster (23%) and Spinal Cord injuries (14%), while for the group with
malignancy were gynecological and breast cancers (12%) and lung cancer (12%). The groups did
not differ in terms of the main symptoms while heartburn and allodynia were the most common
(n=28, 46,7% and n=14, 23,3%, respectively). The anatomical distribution of pain did not differ
between groups while overall it was mostly reported in the lower extremity area (46.7%) and the
pelvis (32.5%). Pain affected patients’ sleep in a different way between the two groups, while the
malignancy group was unable to sleep (36.7% vs 16.7%), reported waking up (45% vs 50%) and
was only able to sleep with drugs (5% vs 1.7%) (p<0.017). In addition, 50.4% of patients had a
moderate psychological state and 31.3% had a poor psychological state, without any differences
between the two groups (p=0.229). NSAIDS were more common in patients without malignancy
(58,3% vs 15,9%, p<0,001). On the contrary, antidepressant use was higher in patients with
malignancy (61,7% vs 28,3%, p<0,001) as well as the anticonvulsant use (91,7% vs 70,0%,
p=0,003). In the category of patients without malignancy, no one received strong opioids
(p<0,001). A high median VAS score of 10 was observed in patients with malignancy compared
with a median of 8 recorded in patients without a malignancy, before initiating treatment. The
changes of VAS score after the 1st and the 2nd medication in the two groups were formed as following: median 7 (malignancy) and 6.5 (non-malignancy) after the 1st medication and 4 and 3
after the 2nd medication respectively.
Conclusion: The characteristics of pain vary considerably but without significant difference
between patients with or without malignancy. The main symptom seemed to be a burning
sensation. In patients without malignancy, treatment starts with mild analgesic drugs and there is
a chance of progressive escalation. In contrast to patients with malignancy, treatment is usually
aggressive and stronger drugs are administered, as their aggravated state of health requires. Finally,
neuropathic pain affects sleep, psychological status and subsequently the quality of life for these
patients.
|
Collections
