PAIN MANAGEMENT IN LUNG CANCERS : EXPERIENCE OF THE MEDICAL ONCOLOGY DEPARTMENT OF HASSAN II HOSPIATL IN FEZ

Despite advances in drug therapy, pain management for patients with lung cancer remains complex. Lung cancer is known to be one of the most painful cancers. Objective: In this study we evaluate the management of pain in patients treated for lung cancer, all stages combined, in the oncology department of the Hassan II University Hospital of Fez. Mean : cross-sectional study of 71 patients collected over a period of one year using a questionnaire specifying the characteristics of the pain, its etiology, the stage of the disease, the analgesic treatments prescribed and the relief obtained by the treatment. Results: The mean age of the patients was 63.5 years with extremes ranging from 48 to 85 years. Male gender was predominant (68%), 67% of patients had metastatic cancer: 42% had bone metastases. Nociceptive pain was assessed by the visual analog scale (VAS) and neuropathic pain by the DN4 Questionnaire. Severe pain, characterized by a VAS score higher than 7, or of moderate intensity with impact on sleep and daily activity, was reported in 60.5% of our patients, mostly young subjects, all with advanced cancer. The pain was acute in 5% of cases, subacute in 32% of patients and chronic in 63% of cases. Neuropathic pain was found in 23% of patients. The pain was controlled by analgesics, level II, in association with an anti-inflammatory agent or antidepressants in 37.3%. 62.7% of patients required morphine. An average daily dose of 60mg of morphine was required to relieve pain, 15 patients reported paroxysmal pain attacks of strong intensity requiring the prescription of sublingual Fentanyl. The use of analgesic radiotherapy in combination with morphine was noted in 10 patients (9.8%). However, a small percentage (2.8%) of patients were resistant to the above-mentioned analgesics, requiring the use of non-drug techniques to relieve them. Conclusion: Our survey confirms the persistent problem of inadequate management of cancer pain. An interesting approach is to improv