Epidemiology and Characteristics of Pain in Blood-Related Disorders: A Longitudinal Study on Italian Adult Hospitalized Patients.
Authors: Niscola Pasquale , Cupelli Luca , Romani Claudio , Cartoni Claudio , Piccioni Daniela , Dentamaro Teresa , Neri Benedetta , Tendas Andrea , Giovannini Marco , Maurillo Luca , Amadori Sergio , De Fabritiis Paolo 
Published: October 2019

Background. In order to investigate the epidemiologic features of pain experienced by hospitalized patients with blood-related diseases, a six months longitudinal study on a consecutive cohort of adult patients has been conducted in four Italian Hospitals.

Patients and Methods. There were 471 patients (221 male) with a median age of 67 (17–89) years. In the event of pain, each pain syndrome (PS) was properly assessed and the pain intensity was reported by a Numerical Analogue Scale (NRS), which rated from 0 (no pain) to 10 (the most severe), or, in less complaint patients, by a verbal description. A treatment approach based on the cancer pain WHO analgesic ladder was recommended.

results. Data on distribution of patients according to the diagnosis and the relative incidence of pain are shown in table 1. Overall, of 471 patients, 175 (37 %) experienced almost one PS for a total of 245. In particular, 112 (64 %), 56 (35.6 %) and 7 (0.4%) presented 1, 2 and 3 distinct PS respectively. Among the 399 patients with malignancies, 165 (41.4%) presented 235 (96%) of the 245 diagnosed PS. Moreover, out of 175 patients who complained pain, 106 (60%) were in advanced phase of disease and collectively accounted for 179/245 (73%) PS. The pathophisiology of the 245 PS was diagnosed as follows: 121 (49 %) deep somatic, deriving from the bone in most cases, 51 (21 %) superficial somatic (mucositis and cutis derangements), and 35 (14 %) visceral, 24 (10 %) neuropathic, 14 (6 %) mixed or by unknown mechanisms. Out of the 35 visceral PS, 28 (80%) were complained by non-Hodgkin’s lymphomas patients. The median pain intensity, according to NRS score was 6 (2–10). The adopted treatment approach, integrating causal interventions and analgesic measures, based on the institutional policy and guidelines of each centre, allowed an effective control of pain (reduction of NRS score of almost 50% within 24 hours) in 225/245 (92%) of the PS. No serious adverse effects were recorded.

Conclusion. Our findings indicate that in the setting of haematological wards:

pain is a significant symptom requiring prompt medical attention and a regular monitoring as the fifth vital sign; most PS can be effectively controlled by the currently available not invasive treatment strategies; the implementation of clinical pathways and standardized protocols based on well-defined algorithms can provide the auspicial advancements toward a “pain-free” haematological hospital.

Table 1. Study results: incidence of pain and distribution of the pain syndromes according to the hematologic diagnosis. Disease Total Patients (%) Patients with pain (Pain Incidence %) Pain Syndromes (% of the total) NHL: Non-Hodgkin’s Lymphoma; AML: Acute Myeloblastic Leukemia; MM: Multiple Myeloma; ALL: Acute Lymphoblastic Leucemia; LPD: others Lymphoproliferative Disorders; MDS: Myelodisplastyc Sindromes; NMD: Non-Malignant Diseases. NHL 141 (30) 56/141 (40) 85 (34) AML 104 (22) 35/104 (34) 47 (19) MM 48 (10) 39/48 (81) 49 (20) ALL 32 (7) 15/32 (47) 26 (11) LPD 34 (8) 8/34 (23) 12 (5) MDS 36 (8) 12/36 (33) 16 (7) NMD 72 (15) 10/72 (14) 10 (4) Total 471 (100) 175/471(37) 245 (100)