Examining pain profiles in cancer patients with and without previous chronic pain presenting to the emergency department.
Authors: Beck Meghan , Schreiber Kristin L. , Flowers Kelsey Mikayla , Johnsky Lily , Chai Peter , Hasdianda Mohammad Adrian , Cremone Gabrielle , Azizoddin Desiree Rachel 
Published: September 2021

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Background: Pain is a common contributing factor to emergency department visits among patients with cancer. Acute exacerbation of pain in cancer patients who have a history of chronic pain poses a potentially greater challenge to pain management and understanding differences between patients with and without historical chronic pain may provide notable insights. The aim of this analysis was to compare aspects of ED healthcare utilization, as well as disease, pain, opioid, and psychosocial factors between cancer patients with or without a history of chronic pain. Methods: Patients presenting to the ED with a complaint of acute pain (> 4/10 NRS) completed validated self-report measures assessing socio-demographics, cancer diagnosis and treatments, pain severity (BPI-SF), medication use (opioids, non-opioid analgesics, cannabis), and psychosocial wellbeing (depression, anxiety, pain catastrophizing, sleep disturbance). Disease and hospital utilization data were abstracted from the medical record. Patients were stratified using the item: “Did you have other chronic pain (pain present for 3 months) at the time of your cancer diagnosis?” Mann-Whitney U, t-tests, and chi-square tests were used to compare differences in psychosocial and pain factors for those with and without previous chronic pain. Results: Approximately a third of the 113 participants reported having another type of chronic pain before cancer. Cancer diagnoses included breast (12%), colon (14%), lung (12%), and ovarian (11%); 74% had current metastatic disease. 43% used opioids, 27% used over-the-counter analgesics, and 6% used cannabis to manage pain. Patients with historical chronic pain reported greater widespread pain (m = 3.90 SD = 2.80 vs. m = 1.80 SD = 1.96, p= < 0.001), significantly higher current pain (m = 6.03 SD = 2.38 vs. m = 4.40 SD = 2.58, p= 0.002), as well as higher mean Brief Pain Inventory scores (m = 5.91 SD = 1.62 vs. m = 4.68 SD = 2.20, p= 0.003). Patients with historical chronic pain reported lower incomes ( p= 0.005), were more likely to have mental health comorbidities (61% vs. 40%, p= 0.039) including depression, substance use, and post-traumatic stress disorder. They were more likely to be prescribed non-opioid analgesics (79% vs. 52%, p= 0.006) and antidepressants (50% vs. 23%, p= 0.003), but not more likely to be taking opioids. There were no significant differences in symptoms of depression, pain catastrophizing, stress, or sleep disturbance, nor were there differences in disease type or length of ED/inpatient stay. Conclusions: Patients with cancer and historical chronic pain reported significantly higher pain than patients without a history of chronic pain. Providers should consider patients’ past experiences with pain when treating cancer pain. Patients with histories of chronic pain may have similar psychological needs as patients without histories of chronic pain.