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. 2016 Apr;36(2):91-6.
doi: 10.14639/0392-100X-499. Epub 2016 Apr 29.

Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy

C Bianchini  1 , M Malagò  1 , L Crema  1 , C Aimoni  1 , T Matarazzo  2 , S Bortolazzi  2 , A Ciorba  1 , S Pelucchi  1 , A Pastore  1
Affiliations

Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy

C Bianchini et al. Acta Otorhinolaryngol Ital. 2016 Apr.

Abstract
in English, Italian

There is increasing interest about all aspects of pain sensation for patients undergoing head and neck surgery, and efforts have been made to better assess, monitor and reduce the occurrence of pain. The aetiology of pain is considered to be "multifactorial", as it is defined by several features such as personal experience, quality perception, location, intensity and emotional impact. The aim of this paper is: (i) to evaluate the efficacy of analgesic treatment in patients with head and neck cancer treated by surgery, and (ii) to study the variables and predictive factors that can influence the occurrence of pain. A total of 164 patients, affected by head and neck cancer and surgically treated, between December 2009 and December 2013, were included in this study. Data collected include age, gender, assessment of anaesthetic risk, tumour localisation, pathological cancer stage, TNM stage, type of surgery performed, complexity and duration of surgery, post-operative complications, postoperative days of hospital stay and pain evaluation on days 0, 1, 3 and 5 post-surgery. We studied the appropriateness of analgesic therapy in terms of incidence and prevalence of post-operative pain; we also related pain to patient characteristics, disease and surgical treatment to determine possible predictive factors. The population studied received adequate pain control through analgesic therapy immediately post-surgery and in the following days. No associations between gender, age and post-operative pain were found, whereas pathological cancer stage, complexity of surgery and tumour site were significantly associated with the risk of post-operative pain. Adequate pain control is essential in oncological patients, and particularly in head and neck cancer patients as the prevalence of pain in this localisation is reported to be higher than in other anatomical sites. Improved comprehension of the biological and psychological factors that characterise pain perception will help to enhance its control in the future.

Negli anni è aumentata l’attenzione verso i molteplici aspetti associati alla “sfera” dolore, anche nei pazienti oncologici sottoposti a chirurgia testa-collo. Il dolore, definito infatti da diverse caratteristiche, quali l’esperienza personale, gli aspetti qualitativi della percezione, l’intensità, l’impatto emotivo, riconosce un’eziologia “multifattoriale”. Scopo del presente lavoro è stato: (i) valutare l’efficacia della terapia analgesica in pazienti affetti da tumore testa-collo e sottoposti a trattamento chirurgico; (ii) studiare le possibili variabili ed i fattori predittivi che possano influenzare l’insorgenza di dolore. Sono stati studiati 164 pazienti, affetti da neoplasia maligna del distretto testa-collo, trattati chirurgicamente tra il dicembre 2009 ed il dicembre 2013. I dati raccolti comprendono l’età, il sesso, la valutazione del rischio anestesiologico, la sede del tumore, la stadiazione TNM, il tipo di intervento effettuato, la complessità e la durata dell’intervento, le eventuali complicanze post-operatorie, i giorni di degenza post-intervento, la valutazione del dolore nei giorni 0, 1, 3 e 5 post-chirurgia. L’adeguatezza della terapia analgesica è stata espressa in termini di incidenza e prevalenza del dolore post-operatorio, le variabili legate al paziente, alla malattia, al trattamento chirurgico e farmacologico, sono state poi associate all’insorgenza del dolore così da poter descrivere eventuali fattori predittivi. Dai dati ottenuti emerge che la popolazione studiata ha ricevuto un’adeguata terapia antalgica, sia nell’immediato post-operatorio che nei giorni successivi. Non sono risultate associazioni statisticamente significative tra sesso, età ed incidenza del dolore post-chirurgico, mentre lo stadio del tumore, la complessità dell’intervento chirurgico e la sede della neoplasia hanno presentano correlazione significativa con il rischio di insorgenza di dolore post-operatorio. L’elevata prevalenza del dolore in ambito oncologico testa-collo, fa sì che un’appropriata ed attenta gestione del dolore risulti fondamentale. Nel futuro pertanto si auspica una sempre migliore comprensione dei fattori biologici, sociali e psicologici che caratterizzano la percezione del dolore ai fini di migliorarne il controllo.

Keywords: Head and neck cancer; Pain; Pain therapy; Quality of life; Surgery.

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Figures

Fig 1.
Fig 1.
Incidence of uncontrolled pain. There is a trend of a gradual pain decrease during hospital stay, with a peak on the day of surgery.
See this image and copyright information in PMC

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