Study of types of pain in MM reveals gaps in communication between doctors and patients

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A study showed that patients with multiple myeloma (MM) deal with physical, social and emotional pain and that doctors did not fully understand how much pain patients were experiencing, suggesting that better communication between the parties is justified.

In addition to experiencing bone pain, patients with multiple myeloma (MM) have been found to experience multiple types of pain, including significant physical, social, and emotional pain, signaling that there is a disconnect between providers of healthcare and patients in how pain symptoms and severity are reported and managed.

The study, the findings of which were published in pain managementfound a mismatch in communication between patients and physicians, which led many physicians to underestimate or underreport pain symptoms and severity in their patients, showing that better communication pain between the parts is necessary.

“Strategies to reduce the burden of bone pain, including patient education about bone health, lifestyle changes, physical activities as prevention techniques, supplements and medications to support bone health and preventing skeletal complications, must also be implemented, as well as optimizing the professional qualification of the attending physician,” the investigators wrote.

Although pain management is known to be an integral part of cancer care and patients with MM have a high symptom burden, pain undertreatment is common. Some of the reasons patients’ pain is undertreated may include that patients and physicians may not have much knowledge or understanding about pain, a physician may not understand the impact of pain on patients cancer patients and potential miscommunication between doctors and patients. Additionally, a patient may be reluctant to admit they are in pain, and there is a lack of published studies on the different aspects of pain that affect people with cancer.

Between November 20, 2018 and February 1, 2018, investigators collected data from the Adelphi Multiple Myeloma Disease Specific Program patient-level database, which contained information from surveys conducted during routine in-person appointments in Germany and Italy. To be eligible, patients had to be 18 years of age or older, have symptomatic MM, and have received first- or second-line MM therapy. A detailed questionnaire was completed by a treating physician for each patient.

A total of 330 patients were included, including 62.7% women and 65.5% retirees. The average age of the cohort was 68 years old. The median time since receiving a diagnosis of MM was 0.97 years.

Overall, 277 patients had clinically significant physical pain, with 73 reporting no physical pain, 161 reporting mild pain, 81 moderate pain, and 15 severe pain. The majority of the cohort (87.6%) reported experiencing bone pain in the 7 days prior to the survey.

Investigators said there was a low level of agreement between patient and physician responses regarding bone pain and bone pain symptoms. It was found that about half of doctors underestimated the severity of bone pain experienced by their patients, and not all patients with bone pain had their symptoms recorded by a doctor.

Of the 327 patients who responded about emotional pain, 58% reported experiencing clinically significant emotional pain. Of the 329 patients who gave responses on social pain, 74 reported clinically important social pain. Emotional and social pain progressively worsened with increasing severity of MM.

“Simply relying on the physical aspect of pain may not adequately reflect the true severity and impact of pain in clinical practice. Our findings suggest that a comprehensive pain assessment should consider not only physical symptoms, but also other dimensions, including social and emotional factors related to disease burden and quality of life,” said the authors. researchers.

The investigators also suggested that physicians take a more holistic approach to pain identification and management, where providers ask open-ended questions to consider all aspects of pain in order to reduce symptoms and improve the quality of life.

The study had some limitations, including the small proportion of patients with severe pain. In addition, data collection during consultations prevented the authors from drawing conclusions about causal relationships.

“As healthcare evolves and patient-physician consultations move from face-to-face clinics to virtual consultations, it is even more important that communication about pain and the burden of disease symptoms is effective and that the patient’s voice is captured accurately,” the investigators noted.

Reference

Quinn B, Ludwig H, Bailey A, et al. Communication of physical, emotional and social pain by patients diagnosed with and living with multiple myeloma. pain management 2022;12(1):59-74. doi:10.2217/pmt-2021-0013

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