Pain and loss of function in head and neck cancer survivors

Head and neck cancers are relatively uncommon malignancies and the characteristics of pain and functional impairments in survivors are not well studied. To characterize the incidence, location, severity, types and causes of pain; associated functional impairments, and pain management methods, the medical charts of 40 consecutive outpatients with biopsy-proven head and neck cancers were reviewed. Pain was severe in 52 % (N = 21), and was located near sites of tumor origin. Pain was caused by tumor recurrence in 35 % (N = 14), treatment sequelae in 30 % (N = 12), multiple etiologies in 25 % (N = 10), and unrelated causes in 10 % (N = 4). Pains were mixed nociceptive and neuropathic pain in 37.5 % (N = 15), nociceptive pain in 32.5 % (N = 13), myofascial in 13.0 % (N = 6), neuropathic in 7.5 % (N = 3); and other mixed types in 7.5 % (N = 3). Despite the high prevalence of dysphagia (82 %), 60 % used orally administered opioid-nonopioid analgesics. Physical disfigurement (87.5 %; N = 35), dysphagia (62.5 %, N = 25), and jaw dysfunction (40.0 %; N = 16) were the most frequent physical impairments. Multiple regression analysis showed that the presence of skull base or mandibular bone involvement had significant influence on the severity of pain (P = 0.03, adjusted R-2 0.25) We conclude that lain in head and neck cancer can be chronic, severe, and persistent despite completion of oncologic treatment. (C) U.S. Cancer Pain Relief Committee, 1999.