SADA-09 BRINGING CLARITY TO SPINE CANCER PAIN: A SYSTEMATIC REVIEW AND PROPOSED TERMINOLOGY

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Abstract Introduction The nature of osseous metastases to the spine are such that patients can develop pain from spinal instability, pathologic fracture, inflammatory or nocturnal pain, and neuropathic pain from compression of neural elements. We sought to evaluate the current literature regarding pain in patients with metastatic spine disease (MSD) and develop more precise terminology to define varying pain syndromes. Methods We conducted a systematic review of pain terminology relevant to patients with MSD according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. Studies were reviewed for distinct classes of pain in patients with MSD. Results A total of 3515 unique citations were reviewed, which was narrowed to 54 full-text citations based on inclusion criteria. Studies were reviewed according to their mention of the International Association for the Study of Pain’s (IASP) comprehensive system to classify pain. Twenty-seven (50%) of studies mentioned IASP Group D (treatment related) pain and 18 (33.3%) describe Group A (nociceptive) pain syndromes. The authors propose that in order to characterize pain for patients with MSD, symptoms should be classified in a way that characterizes whether pain will respond to an intervention using the following framework: 1. Tumor related/ biologic, 2. Mechanical, 3. Radicular, 4. Neuropathic, and 5. Treatment related. This terminology was developed by the members of the AO Knowledge Forum Tumor international group. Conclusion The authors present an approach to nomenclature for neoplastic spinal pain which can be used to communicate the clinical status of patients with MSD between surgeons, radiation oncologists, and medical oncologists.

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