Despite Prevalence, Pain Management May Be Undermanaged in Patients with MPNs

More than half of patients with myeloproliferative neoplasms (MPNs) report feeling pain that is related to the disease, most commonly abdominal discomfort (53.2 percent) and bone pain (48.5 percent). Yet, despite its prevalence, chronic pain may be significantly undermanaged in these patients, according to recent research presented at the 2018 American Society of Hematology (ASH) Annual Meeting.

“To date, little is known about patient viewpoints on MPN pain, its relationship to other chronic pain syndromes and the impact of pharmacologic and non-pharmacologic pain therapies,” the researchers wrote in an abstract presented at the meeting. “In this study, we performed an international survey of MPN patients to better understand the prevalence and management of MPN pain.”

More than 500 patients with MPNs — including myelofibrosis (26.9 percent), polycythemia vera (44.2 percent) and essential thrombocythemia (28.9 percent) – filled out a 27-item survey that assessed their belief barriers to optimal management of cancer-related pain. The survey included a series of questions that participants ranked their answers on a scale of 0 (do not agree at all) to 5 (agree very much).

Patients reported that they believe that cancer can cause pain but weren’t expecting it. Overall, 42.3 percent of patients said that they were unsatisfied with their current pain management plan. However, only 43.5 percent patients reported that their health care providers discussed pain during office visits.

“Chronic pain is a prevalent and undermanaged feature of MPN disorders. Chronic non-MPN pain is further complicated by the development of the disorder,” the researchers wrote. “Many patients (with MPNs) lack understanding on its prevalence and furthermore feel ill-equipped to manage it. Patients have, however, found symptomatic benefit from various pharmacological and non-pharmacological treatment modalities that require further explanation.”

Patients also completed the MPN-10, a 10-item survey of MPN symptoms completed on a scale of 0 (absent) to 10 (worst imaginable), which was an average of 28.3 among all patients. The score for both abdominal discomfort and bone pain was 3, indicating a low to moderate symptom burden, the researchers wrote.

Most patients reported their chronic pain had either stayed the same (26.2 percent), worsened (28.3 percent) or significantly worsened (14.5 percent) following their diagnosis; however, many found pharmacologic and non-pharmacological therapies to be effective for individual pain symptoms.

In total, 42.1 percent described regularly taking medication to control their pain, including acetaminophen, anti-inflammatory drugs and opioids, while other people preferred a more integrative approach, and tried yoga, exercise, massage and acupuncture.

“Results from this study suggest MPN patients should be assessed regularly for pain and offered early referral to specialized services for evaluation, source identification and treatment,” the researcher wrote.