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BMC Palliative Care
Published in: BMC Palliative Care 1/2015

Open Access 01-12-2015 | Research article

Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study

Authors: Alfonso Gomez-Iturriaga, Jon Cacicedo, Arturo Navarro, Virginia Morillo, Patricia Willisch, Claudia Carvajal, Eduardo Hortelano, Jose Luis Lopez-Guerra, Ana Illescas, Francisco Casquero, Olga Del Hoyo, Raquel Ciervide, Ana Irasarri, Jose Ignacio Pijoan, Pedro Bilbao

Published in: BMC Palliative Care | Issue 1/2015

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Abstract

Background

Palliative radiotherapy (RT) is an effective treatment for symptomatic bone metastases. Pain flare, a transient worsening of the bone pain after RT, has been described in previous reports with different incidence rates. The aim of the study was to prospectively evaluate the incidence of pain flare following RT for painful bone metastases and evaluate its effects on pain control and functionality of the patients.

Methods

Between June 2010 and June 2014, 204 patients were enrolled in this study and 135 patients with complete data were evaluable. Pain flare was defined as a 2- point increase in worst pain score as compared with baseline with no decrease in analgesic intake or a 25 % increase in analgesic intake as compared with baseline with no decrease in worst pain score. All pain medications and worst pain scores were collected before, daily during, and for 10 days after RT. The Brief Pain Inventory (BPI) was filled out on the pretreatment and at the 4 weeks follow-up visit.

Results

There were 90 men (66.7 %) and 45 women (33.3 %). Mean age was 66 years (SD 9.8). The most common primary cancer site was lung in 42 patients (31.1 %), followed by prostate in 27 patients (20.0 %). Forty-two patients (31.1 %) patients received a single fraction of 8 Gy and 83 (61.5 %) received 20 Gy in five fractions.
The overall pain flare incidence across all centers was 51/135 (37.7 %). The majority of pain flares occurred on days 1–5 (88.2 %). The mean duration of the pain flare was 3 days (SD: 3). There were no significant relationships between the occurrence of pain flare and collected variables.
All BPI items measured four weeks after end of RT showed significant improvement as compared with pretreatment scores (p < 0.001). No significant differences in BPI time trends were found between patients with and without flare pain.

Conclusion

Pain flare is a common event, occurring in nearly 40 % of the patients that receive palliative RT for symptomatic bone metastases. This phenomenon is not a predictor for pain response.
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Metadata
Title
Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study
Authors
Alfonso Gomez-Iturriaga
Jon Cacicedo
Arturo Navarro
Virginia Morillo
Patricia Willisch
Claudia Carvajal
Eduardo Hortelano
Jose Luis Lopez-Guerra
Ana Illescas
Francisco Casquero
Olga Del Hoyo
Raquel Ciervide
Ana Irasarri
Jose Ignacio Pijoan
Pedro Bilbao
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2015
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-015-0045-8

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