Palliative Medicine Reports (May 2021)

C-Reactive Protein and Its Relationship with Pain in Patients with Advanced Cancer Cachexia: Secondary Cross-Sectional Analysis of a Multicenter Prospective Cohort Study

  • Koji Amano,
  • Hiroto Ishiki,
  • Tomofumi Miura,
  • Isseki Maeda,
  • Yutaka Hatano,
  • Shunsuke Oyamada,
  • Naosuke Yokomichi,
  • Keita Tagami,
  • Takuya Odagiri,
  • Tetsuya Ito,
  • Mika Baba,
  • Tatsuya Morita,
  • Masanori Mori,
  • Satoshi Inoue,
  • Kengo Imai,
  • Hiroaki Tsukuura,
  • Toshihiro Yamauchi,
  • Akemi Shirado Naito,
  • Yu Uneno,
  • Akira Yoshioka,
  • Shuji Hiramoto,
  • Ayako Kikuchi,
  • Tetsuo Hori,
  • Yosuke Matsuda,
  • Hiroyuki Kohara,
  • Hiromi Funaki,
  • Keiko Tanaka,
  • Kozue Suzuki,
  • Tina Kamei,
  • Yukari Azuma,
  • Teruaki Uno,
  • Jiro Miyamoto,
  • Hirofumi Katayama,
  • Hideyuki Kashiwagi,
  • Eri Matsumoto,
  • Kiyofumi Oya,
  • Takeya Yamaguchi,
  • Tomonao Okamura,
  • Hoshu Hashimoto,
  • Shunsuke Kosugi,
  • Nao Ikuta,
  • Yaichiro Matsumoto,
  • Takashi Ohmori,
  • Takehiro Nakai,
  • Takashi Ikee,
  • Yuto Unoki,
  • Kazuki Kitade,
  • Shu Koito,
  • Nanao Ishibashi,
  • Masaya Ehara,
  • Kosuke Kuwahara,
  • Shohei Ueno,
  • Shunsuke Nakashima,
  • Yuta Ishiyama,
  • Akihiro Sakashita,
  • Ryo Matsunuma,
  • Hana Takatsu,
  • Takashi Yamaguchi,
  • Satoko Ito,
  • Toru Terabayashi,
  • Jun Nakagawa,
  • Tetsuya Yamagiwa,
  • Akira Inoue,
  • Takuhiro Yamaguchi,
  • Mitsunori Miyashita,
  • Saran Yoshida,
  • Yusuke Hiratsuka,
  • Hiroaki Watanabe,
  • Masayuki Ikenaga,
  • Keiji Shimizu,
  • Akira Hayakawa,
  • Rena Kamura,
  • Takeru Okoshi,
  • Tomohiro Nishi,
  • Kazuhiro Kosugi,
  • Yasuhiro Shibata,
  • Takayuki Hisanaga,
  • Takahiro Higashibata,
  • Ritsuko Yabuki,
  • Shingo Hagiwara,
  • Miho Shimokawa,
  • Satoshi Miyake,
  • Junko Nozato,
  • Tetsuji Iriyama,
  • Keisuke Kaneishi,
  • Yoshihisa Matsumoto,
  • Ayumi Okizaki,
  • Yuki Sumazaki Watanabe,
  • Yuko Uehara,
  • Eriko Satomi,
  • Kaoru Nishijima,
  • Junichi Shimoinaba,
  • Ryoichi Nakahori,
  • Takeshi Hirohashi,
  • Jun Hamano,
  • Natsuki Kawashima,
  • Takashi Kawaguchi,
  • Megumi Uchida,
  • Ko Sato,
  • Yoichi Matsuda,
  • Satoru Tsuneto,
  • Sayaka Maeda,
  • Yoshiyuki Kizawa

DOI
https://doi.org/10.1089/PMR.2021.0004

Abstract

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Background: Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer. Objectives: To investigate the relationship between serum levels of CRP and subtypes of pain. Design: A secondary cross-sectional analysis of a prospective cohort study. Setting/Subjects: Patients with advanced cancer admitted to 23 palliative care units in Japan. Measurements: Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal?Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated. Results: We divided 1513 patients into four groups: low CRP (n?=?234), moderate CRP (n?=?513), high CRP (n?=?352), and very high CRP (n?=?414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (p?<?0.001) and 0.16 (p?<?0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 [95% CI 1.14?2.88], p?=?0.01; 1.74 [95% CI 1.18?2.57], p?=?0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain. Conclusions: The results indicated direct relationships between CRP, pain NRS, and pain IPOS.

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