477: A Cross-Sectional Assessment of Cancer-Related Pain Severity in Palliative Care Patients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Assessment and Measurement of Pain/Nociception

Background and Aims: Cancer-related pain is a prevalent, complex, and multidimensional symptom that significantly impairs quality of life, particularly in patients with advanced disease.1 It may arise from direct tumor invasion, diagnostic or therapeutic procedures, or treatment-related adverse effects.
One of the primary goals of palliative care is effective pain relief. However, the subjective nature of pain necessitates accurate and systematic assessment for optimal management. Validated tools such as the Visual Analog Scale (VAS), Numerical Rating Scale (NRS), and Verbal Rating Scale (VRS), along with behavioural scales for non-communicative patients, are essential for evaluating pain. 2 Comprehensive assessment should include pain intensity, quality, duration, and its functional impact. Regular evaluation enables clinicians to individualize analgesic therapy and monitor treatment response.
Despite advances, cancer pain remains inadequately assessed, underscoring the need for continued research, refined strategies, and updated guidelines to improve pain severity evaluation and adequacy of analgesic management in palliative care.

Methods: This cross-sectional, observational study will be conducted among 86 adult cancer patients receiving palliative care to assess pain severity and the adequacy of analgesic management. Patients with confirmed cancer and pain will be enrolled after informed consent; those unable to respond will be excluded. Pain intensity will be evaluated using the Visual Analog Scale (VAS) including percentage changes to evaluate variations. The appropriateness of analgesic therapy will be determined using the Pain Management Index (PMI), which correlates pain intensity with the potency of prescribed analgesics. PMI scores range from −3 (severe pain with no analgesia) to +3 (adequate analgesia), calculated by subtracting the pain level from the analgesic score.
Data was collected through direct patient interviews using a structured questionnaire. Demographic and clinical details was also be recorded. All patients will continue to receive standard palliative care throughout the study.

Results: Among 86 participants, the mean VAS score was 4.92 (SD 2.73), with a median of 5 and IQR 2.75–7, indicating moderate pain with notable variability.
PMI assessment showed most patients had negative scores (−1 or −2), suggesting inadequate pain management, while only 7% had adequate control.
Analysis of analgesic use based on the World Health Organization ladder showed that 62.8% of patients were managed with Step 1 (non-opioid analgesics). Strong opioids (Step 3) were used in only 1.2% of cases, reflecting limited utilization. Additionally, 12.8% of patients were not receiving any analgesia, possibly due to absence or lower severity of pain in early disease stages. Overall, the findings highlight suboptimal pain management in this cohort.
Chemotherapy (47.6%) and radiotherapy (43%) were commonly used, with surgery less frequent (23.2%). Moderate pain persisted across all treatment groups, highlighting overall suboptimal pain management.

Conclusions: This study highlights that cancer patients in palliative care experience moderate pain with variable control, and a substantial proportion receive inadequate analgesic management. Despite the use of validated tools such as VAS and PMI, 62.8% of patients had negative PMI scores, indicating undertreatment of pain.
A predominance of non-opioid (Step 1) analgesics and minimal use of strong opioids suggests a cautious prescribing pattern, likely influenced by regulatory concerns. However, this may contribute to inadequate pain relief, especially in patients with moderate pain across treatment modalities such as chemotherapy, radiotherapy, and surgery. The presence of untreated patients (12.8%) and newly diagnosed individuals without pain further reflects the heterogeneity of the cohort.
Overall, the findings emphasize the need to re-evaluate pain management strategies, ensure appropriate escalation as per guidelines, and balance opioid-related concerns with effective symptom relief to improve quality of life in palliative care settings.

References: 1.Caraceni A, Shkodra M. Cancer Pain Assessment and Classification. Cancers (Basel). 2019 Apr 10;11(4):510. doi: 10.3390/cancers11040510.
2. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–93.

Presenting Author: Shradha Prasad
Submitting Author: Shradha Prasad

Senior Author: Madhu Dayal

IASP 2026 Global Year theme of Neuropathic Pain: No

• Premkumar Madhu Dunna: MBBS, MD - Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
• Madhu Dayal: MBBS, MD - Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India