Journal of Pain Research (Aug 2023)
Head and Neck Cancer-Related Pain: A Descriptive Analysis of the Pain Phenotypes
Abstract
Shehryar Khawaja,1– 3 Roxanne Bavarian,4 Summaiya Abdul Rehman,1 Haroon Hafeez1 1Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan; 2Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 3Department of Oral Diagnostic Sciences, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA; 4Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USACorrespondence: Shehryar Khawaja, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3 M.A. Johar Town, Lahore, 54782, Pakistan, Tel +92 42 3590 5000 Ext 4452, Email [email protected]: This study aimed to describe the clinical characteristics and prevalence of different painful phenotypes in head and neck cancer (HNC)-related pain.Materials and Methods: A cross-sectional study was conducted on 100 patients who presented with HNC-related pain. All patients underwent a comprehensive clinical assessment and were stratified in one or more painful phenotypes constructed based on the International Classification for Orofacial Pain, first edition, and International Classification for Headache Disorders, third edition.Results: Among the participants included, 68% were male, and the mean age of the cohort was 49.71 ± 14.14 years. The most prevalent cancer sites were the tongue (29%) and buccal mucosa (24%). The average pain intensity was 5.88 ± 2.53 on an 11-point numeric verbal pain rating scale, where 0 was indicative of “no pain” and 10 was suggestive of “worst pain imaginable”. However, the worst pain intensity over the last month was 8.95 ± 1.53. The average number of pain sites per patient was 6, and the most common pain descriptors were dull ache, burning, and sharpness. Myofascial pain, jaw bone pain, and burning pain disorder were the most common phenotypes, and on average, three different phenotypes co-existed.Conclusion: HNC-related pain has a varying and complex clinical profile, which may mirror the pain profiles of primary pain disorders, such as myofascial pain, jaw bone pain, or burning pain disorders, and often presents together as a cluster of phenotypes.Plain language summary: The clinical presentation of head and neck cancer (HNC)-related pain varies considerably. This study assessed 100 patients with HNC-related pain. It stratified their symptoms into one or more known painful disorders based on the International Classification for Orofacial Pain, first edition and International Classification for Headache Disorders, third edition. It was found that HNC-related most commonly resembled myofascial pain, jaw bone pain, and burning pain disorder. On average, features of three different types of painful disorders co-existed. These results help illustrate the uniqueness and difficulty associated with managing HNC-related pain.Keywords: head and neck cancer, pain, phenotypes, myofascial, neuralgia, neuropathic, trigeminal
