Chronic Post-Treatment Pain in Head and Neck Cancer Survivors: A Descriptive Analysis of Phenotypic Overlap

Chronic post-treatment pain (CPTP) affects up to 42% of head and neck cancer (HNC) survivors, significantly reducing quality of life. Its diverse clinical presentations remain poorly characterized. This study aimed to delineate the distinct painful phenotypes in CPTP following curative HNC treatment.

A prospective cross-sectional study enrolled 100 adult HNC survivors presenting to the Orofacial Pain Clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Patients with oropharyngeal mucositis, hardware failure, infection, or refractory disease were excluded. Painful phenotypes-orofacial bone pain, myofascial pain disorder, neuralgia, persistent pain disorder, and burning pain disorder-were classified using ICOP (1st edition) and ICHD-3 criteria.

The cohort was 54% male, mean age 49.6 ± 10.3 years. Pain was predominantly unilateral (62%) and constant (85%), with mean intensity 5.3 ± 1.8 and worst intensity 7.7 ± 1.3. Common descriptors included dull ache, burning, throbbing, and stabbing. Masticatory and cervical myofascial pain and oral burning pain were most prevalent, with participants exhibiting an average of two co-existing phenotypes.

CPTP in HNC survivors encompasses an amalgamation of overlapping clinical phenotypes analogous to primary pain disorders. Recognizing these phenotypes can improve diagnostic accuracy and guide individualized therapeutic interventions.