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A secondary analysis: the impact of pre-existing chronic pain among patients with cancer presenting to the emergency department with acute pain

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Abstract

Purpose

Patients with cancer may experience pain from cancer itself or its treatment. Additionally, chronic pain (CP) predating a patient’s cancer diagnosis may make the etiology of pain less clear and the management of pain more complex. In this brief report, we investigated differences in biopsychosocial characteristics, pain severity, and opioid consumption, comparing groups of cancer patients with and without a history of CP who presented to the emergency department (ED) with a complaint of cancer-related pain.

Methods

This secondary analysis of a prospective cohort study included patients with cancer who presented to the ED with a complaint of pain (≥ 4/10). Sociodemographic, clinical, psychological, and pain characteristics were assessed in the ED and subsequent hospitalization. Mann-Whitney U-, T-, and Chi-square tests were used to compare differences between patients with and without pre-existing CP before cancer.

Results

Patients with pre-existing CP had lower income (p = 0.21) and less formal education (p = 0.25) and were more likely to have a diagnosis of depression or substance use disorder (p < 0.01). Patients with pre-existing CP reported significantly greater pain severity in the ED and during hospitalization compared to those without pre-existing CP (p < 0.05), despite receiving greater amounts of opioid analgesics (p = 0.036).

Conclusion

Identifying a history of pre-existing CP during intake may help identify patients with cancer with difficult to manage pain, who may particularly benefit from multimodal interventions and supportive care. In addition, referral of these patients for the management of co-occurring pain disorders may help decrease the usage of the ED for undertreated pain.

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Acknowledgements

Mohammad Adrian Hasdianda, Lily Johnsky, and other research and healthcare staff in Brigham and Women’s Hospital Emergency Department, as well as all participants are acknowledged.

Funding

This study was supported by NIH R35 GM128691 (KLS), National Palliative Care Research Center (DRA), NIH NCI K08 CA266937 (DRA), NIH K23 DA044874, and DP2DA056107 (PRC).

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Meghan Beck, Kristin L. Schreiber, Jenna M. Wilson, K. Mikayla Flowers & Robert R. Edwards

  2. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Peter R. Chai & Desiree R. Azizoddin

  3. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Peter R. Chai & Desiree R. Azizoddin

  4. Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA

    Peter R. Chai

  5. The Fenway Institute, Boston, MA, USA

    Peter R. Chai

  6. TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Desiree R. Azizoddin

Authors
  1. Meghan Beck
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  7. Desiree R. Azizoddin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MB, KLS, MFl, and DRA. The first draft of the manuscript was written by MB and DRA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Desiree R. Azizoddin.

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Ethics approval

The study protocol was approved by Mass General Brigham IRB (no.: Partners IRB 2019P002230 approved 09/10/2019). Participants provided informed consent to participate and study activities conformed to the 1964 Helsinki Declaration and following amendments.

Conflict of interest

The authors declare no competing interests.

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Beck, M., Schreiber, K.L., Wilson, J.M. et al. A secondary analysis: the impact of pre-existing chronic pain among patients with cancer presenting to the emergency department with acute pain. Support Care Cancer 32, 129 (2024). https://doi.org/10.1007/s00520-024-08314-8

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