Pain experienced by patients with terminal head and neck carcinoma

Y. P. Talmi*, A. Waller, M. Bercovici, Z. Horowitz, M. R. Pfeffer, A. Adunski, J. Kronenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Pain is one of the most feared consequences of cancer and is experienced by up to 80 per cent of patients with head and neck carcinoma (HNC). Pain in terminal HNC patients is common and often defined as severe. This study evaluated the effectiveness of the World Health Organization (WHO) analgesic ladder in the treatment of a cohort of terminal HNC patients. METHODS: The authors prospectively evaluated 62 consecutive terminal HNC patients admitted to the Chaim Sheba Medical Center Tel Hashomer Hospice or the general hospital. Data pertaining to tumour origin, spread, treatment, and results were defined. Pain was assessed with the McGill Pain Questionnaire, using a 10-point visual analogue scale (VAS) and a body map. Pain was diagnosed according to cause and type. Treatment was selected according to the guidelines provided in the WHO analgesic ladder. RESULTS: Only 10 patients suffered from pain that was not locoregional. The results of the VAS score were available in the first reading in all patients with pain (n = 48), with a mean of 4.7 (standard deviation (SD) ± 2.0). A mean second VAS score obtained 72 hours after the first was 1.9 (SD ± 1.1). The difference between the two scores was statistically significant (p<0.001). A third score was available for only six patients, with a mean of 1.6. Only two patients did not experience improvement of pain after 72 hours of treatment; both of these patients had bony involvement with tumour. Thirty-one patients (65 per cent) were diagnosed with pain of nociceptive origin; these patients were categorized as having actual nociceptive pain (22), nociceptive nerve pain (six), or referred pain to the ear (three). Nonnociceptive pain of neuropathic origin was noted for only six patient (12.5 per cent). Pain that could not be well defined but was responsive to opioid analgesic treatment was noted for 11 patients. A different form of non-cancer-related pain was noted for only one patient. CONCLUSIONS: Patients were treated for pain according to the WHO analgesic ladder. They received adequate narcotic analgesics and supportive measures that allowed significant reduction of pain in nearly all cases, with acceptable side effects, Author.

Original languageEnglish
Pages (from-to)113-114
Number of pages2
JournalJournal of Laryngology and Otology
Issue number1
StatePublished - 1998
Externally publishedYes


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