Study on Types of Pain in MM Reveals Communication Inadequacies Between Physicians, Patients

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

The study, findings of which were published in Pain Management, found discordance in the communication between patients and physicians, leading to many physicians underestimating or underreporting pain symptoms and severity among their patients, showing that improved pain communication between parties is needed.

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

Despite knowing that pain management is integral to cancer care and that patients with MM experience a high symptom burden, undertreatment of pain is common. Some of the reasons that patients’ pain goes undertreated can include that patients and physicians may not have a lot of knowledge or understanding about pain, a physician may fail to understand the impact of pain on patients with cancer, and potential poor communication between physicians and patients. Additionally, a patient may be reluctant to admit that 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, the investigators collected data from the Adelphi Multiple Myeloma Disease Specific Programme patient-level database, which contained information from surveys that were conducted during routine in-person appointments in Germany and Italy. For eligibility, patients had to be 18 years or older, have symptomatic MM, and have received either first-line or second-line MM therapy. A detailed questionnaire was completed by a treating physician for each patient.

In total, 330 patients were included, 62.7% of whom were women and 65.5% were retired. The mean age of the cohort was 68 years. The median time since receiving an MM diagnosis was 0.97 years.

Overall, 277 had clinically important physical pain, with 73 reporting no physical pain, 161 reporting mild pain, 81 experiencing moderate pain, and 15 patients having severe pain. Most of the cohort (87.6%) said that they had experienced bone pain during the 7 days prior to the survey.

The investigators said that there was a low level of agreement between patient and physician responses regarding bone pain and bone pain symptoms. About half of physicians were found to have underestimated the severity of bone pain that their patients experienced, and not all patients who experienced bone pain had their symptoms recorded by a physician.

Of the 327 patients who responded about emotional pain, 58% said that they experienced clinically important emotional pain. Among the 329 patients who gave responses about social pain, 74 reported clinically important social pain. Emotional and social pain became progressively worse with increasing MM severity.

“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 assessment of pain must consider not just physical symptoms but also other dimensions, including social and emotional factors relating to burden of disease and quality of life,” said the investigators.

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

The study had some limitations, including that the proportion of patients with severe pain was small. Also, collecting data during consultations prevented the authors from making conclusions on causal relationships.

“As healthcare evolves and patient–physician consultations shift from face-to face clinics to virtual consultations, it is even more important that communication on pain and symptom burdens of disease are effective, and the patient voice is captured accurately,” the investigators noted.

Reference

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