Pain-Reported Pain Severity Is Associated with Poor Outcomes in Multiple Myeloma

In patients with multiple myeloma (MM), higher patient-rated pain severity was found to be significantly associated with poorer health-related quality of life (HRQOL). This study was published in Cancer Reports.

The goal of this study was to assess the clinical relevance of patient-reported pain severity in MM treatment. “Although pain management is an integral part of cancer care, pain is underreported, misunderstood, and often undertreated,” wrote the study authors. “To provide care that is meaningful to patients with MM, capturing and understanding the patient perspective are therefore essential.”

Real-World Data on Pre-Treated MM

The researchers assessed point-in-time data from the Adelphi Multiple Myeloma Disease Specific Programme database. In total, 330 patients being treated for MM between November 2017 and February 2018 were included. Median patient age was 70 years and 62.7% were female.

Around half of patients (48.5%) had lived longer than 1 year with MM and 17.3% had lived with MM for >3 years. Cardiovascular disease was the most common comorbidity, present in 51.2% of patients. Nearly half of patients had International Staging System stage III disease and were receiving second-line or higher treatment. Combination chemotherapy was the most common treatment at time of survey, across all lines of therapy.

HRQOL was assessed via functional assessments, including the Work Productivity and Activity Impairment (WPAI) scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 20-item myeloma-specific questionnaire (EORTC QLQ-MY20) and the Core-30 questionnaire (EORTC QLQ-C30) questionnaire.

Patient-rated pain severity was measured through a single-question survey: “Please tick the box that best describes the level of pain that you are currently experiencing.” Patients chose one response from “no pain,” “mild pain,” “moderate pain,” or “severe pain.” The median time between MM diagnosis and time of survey was 0.96 years.

Severe Pain in 4.6% of Patients

When surveyed, 73 patients reported “no pain” (22.0%); 161 reported “mild pain” (48.8%); 81 reported “moderate pain” (24.6%); and 15 reported severe pain (4.6%). Half of patients reporting no pain were aged <65 years and 46.6% had no diagnosed comorbidities. Use of analgesics was 13.7% in patients with no pain, compared to 53.3% of patients with severe pain.

More than half (55%) of patients overall reported bone pain within one week prior to taking the survey. Most patients (>95%) who reported any kind of pain experienced bone pain within one week prior, and all patients with severe pain reported recent bone pain. Among patients with no pain, 45.2% did not report bone pain within seven days of the survey.

Patient self-reported pain severity was significantly negatively correlated with HRQOL assessment scores. From no pain to severe pain, mean overall HRQOL scores decreased from 70.2 to 33.3 (P<0.001). Increasing pain severity was associated with decreases in mean EORTC QLQ-C30 physical, social, emotional, and role subscores (all P<0.001). Mean scores for WPAI usual activity impairment and EORTC QLQ-C30 fatigue burden subscores increased with higher pain severity (all P<0.001).

In conclusion, the authors wrote, “This study demonstrates that the use of a single question can capture the patient’s perspective on pain and HRQOL,” wrote the authors in conclusion. “We observed that a higher level of patient self-reported pain severity was related to poorer HRQOL. … Hence, a simple and direct approach for understanding pain severity may simplify and expedite HRQOL assessment and may also guide physicians in choosing treatment options to reduce and alleviate pain and improve HRQOL in patients with MM.”