Pain Undertreated in mCRPC Patients

Pain is undertreated in patients with metastatic castration-resistant prostate cancer (mCRPC), results of a recent study show. Even patients with severe pain report underuse of analgesics.

Ethan M. Basch, MD, MSc, of the University of North Carolina in Chapel Hill, and colleagues studied 461 prostate cancer patients, of whom 147 had mCRPC involving bone. Of these, 61% were exposed to docetaxel and 39% were not. Researchers used the Brief Pain Inventory (BPI) instrument to evaluate pain and various factors related to it. The BPI measures pain using a 0 to 10 numeric rating scale in which 0 indicates “no pain” and 10 indicates “pain as bad as you can imagine.”

Pain of any level was more common among docetaxel-exposed patients than docetaxel-naïve patients in mCRPC (70% vs. 38%). Results showed that 38% of docetaxel-exposed patients reported a BPI score of 4 or higher (“moderate pain”) compared with 24% of docetaxel-naïve patients, Dr. Basch's group reported online ahead of print in the Journal of Oncology Practice. Results showed that 40% of patients with a pain intensity of 4 or higher reported no current narcotic analgesic use. Among patients with BPI scores of 7 or higher (“severe” pain), only 27% reported use of a long-acting narcotic and 18% reported no analgesic at all.

“A striking finding of this study is the apparent underuse of analgesics, including narcotic analgesics, among the men with pain, consistent with other recent reports,” the authors wrote.

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