Association of severe pain with poor response to opioids, psychological distress, and aberrant drug taking behaviors in a large cohort of cancer patients.

9600 Background: Pain is one of the most feared consequences of cancer. Systematic reviews indicate opioids are effective for cancer pain, but are often under-utilized. At the same time, there is increased societal concern about opioid abuse. Identifying patients with a history of cancer who are at risk for poor pain outcomes is important when considering opioid therapy. The aim of this study was to evaluate associations between pain intensity, analgesic effectiveness, disability, distress and aberrant drug taking in the subpopulation from Memorial Sloan Kettering Cancer Center of a pain clinic registry. Methods: At each outpatient encounter, patients completed the Brief Pain Inventory, Condensed Memorial Symptom Assessment Scale (CMSAS) and Current Opioid Misuse Measure (COMM). Though not yet validated in patients with cancer, in other chronic pain populations a COMM score greater than 9 has a positive likelihood ratio for diagnosing opioid misuse/abuse of 3.5. Data analysis performed by International Severity Information Systems, Salt Lake City, UT. Results: From 6/18/2011 to 12/10/2014, 1593 of 2085 (76.4%) patients completing 5599 surveys reported continuing pain despite taking opioids. Average pain score was mild (1-4) in 25%, moderate (5-6) in 41%, severe (7-10) in 34%. Those with severe pain reported less relief from their pain medicine, were more disabled (higher pain interference), and had more physical and psychological distress and higher COMM scores (see Table, all p values < 0.001). Conclusions: Ambulatory patients with a cancer history who report severe pain despite taking opioids are a challenging management problem. These data suggest they have concomitant disability, physical and psychological distress, and behaviors suggestive of opioid misuse/abuse. To improve their outcomes, more research is needed to understand the causal links between these associations. Score Mild Moderate Severe Average pain intensity 3.2 5.5 7.8 Pain relief 62% 54% 45% Pain interference 4.0 5.6 7.0 Physical symptom distress score, CMSAS 1.5 1.7 1.9 Psychological distress score, CMSAS 1.3 1.6 2.0 COMM score 8.1 8.5 10.7