Early analgesic response to interventional pain procedures in hospitalized patients with cancer-related pain: clinical predictors and exploratory survival analysis

Vollständiger Abstract

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Abstract Purpose Interventional pain procedures (IPPs) are increasingly considered earlier for cancer-related pain, yet the clinical predictors and prognostic relevance of early analgesic response to IPP remain unclear. We aimed to identify predictors of early response and evaluate its implication for 1-year survival outcomes. Methods This retrospective cohort study included 349 hospitalized cancer patients undergoing their first inpatient IPP. Early analgesic response was defined by changes in daily mean NRS scores and morphine equivalent daily dose (MEDD) over a 48-h peri-procedural period. Based on these criteria, patients were categorized into overall responders and non-responders. Independent predictors of this early response were identified using multivariable logistic regression, and 1-year survival outcomes were evaluated using Kaplan–Meier analysis with the log-rank test and multivariable Cox proportional hazards regression. Results Among 349 patients, overall responders (25.5%) were independently associated with higher baseline NRS (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.63–2.83; P < 0.001) and lower baseline MEDD (OR, 0.95 per 10-mg increase; 95% CI, 0.92–0.98; P < 0.001). In multivariable Cox regression, early analgesic response was not independently associated with 1-year mortality (adjusted hazard ratio for non-responders vs. overall responders, 1.26; 95% CI, 0.90–1.77; P = 0.176), although univariable analysis indicated a significant survival advantage (log-rank test, P = 0.037). Conclusion Higher pain intensity and lower opioid use predict a favorable early analgesic response to IPP, suggesting an optimal therapeutic window for cancer-related pain intervention. Early analgesic response to IPP may serve as an exploratory prognostic indicator in patients with cancer-related pain.