Abstract

Background: Patients with intractable cancer pain from the abdomen or dyspnea from lung cancer sometimes sleep sitting in an upright position, with the bed back up, or in a reclining position, all day long. They referred to the pain clinic due to little or no therapeutic effect on their intractable neck, chest or abdominal, flank, or back pain even though they take an increased dose of analgesics. Prevalence of facet joint syndrome (FJS) in cancer patient who were referred to a pain clinic was evaluated.
Methods: Patients with cancer pain who referred to the pain clinic for 10 years were enrolled. The prevalence of concomitant FJS was checked. Among the FJS patients, the presence of spine metastases adjacent to the FJS, the performance of percutaneous vertebroplasty (PVP), the origin of primary cancer, the stage of the cancer, sleeping pattern, and pain numeric analogue scale (NRS) scores before and after removal of facet joint pain were also evaluated.
Results: Ninety-two of four hundred sixty seven (19.7%) referred patients (M:F = 48:44, age = 62.5 ± 14.5) had FJS. The level of FJS in the thoracic (73), lumbar (16), and cervical (3) spine, in order of frequency. The prevalence of spine metastases adjacent to the FJS was 43.5% (40 of 92 FJS patients). Twenty-one (22.8%) patients received PVPs after FJ injections. In patients with FJS, the common origin of the primary cancer was the lung, multiple myeloma, stomach, liver, and pancreas. Ninety-one of ninety-two patients (99%) had stage 4 cancers. All patients had sleeping disturbance in an abnormal position. The NRS score was decreased from severe to moderate range of pain after the FJ injections while maintaining total daily analgesics.
Conclusion: Almost one of fifth referred patients with cancer had FJS. The half of the FJS patient had spine metastases, the half of patients with spine metastases received PVPs. The other half of FJS patients may result from the benign causes, such as abnormal position due to pain or dyspnea or degenerative changes. Attention should be given any concomitant facet joint syndrome instead of increasing daily dose of analgesics, unless a rapid or prominent progression of the cancer is apparent.
Key Words: Attention; Back; Cancer pain; Dyspnea; Facet joint; Lung cancer; Multiple myeloma; Opioid analgesics; Prevalence; Sleep disorders; Stomach; Liver.
REFERENCES
1. Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29: iv166-91.