Pain Syndrome Characteristics and Analgesic Therapy Optimization in Incurable Patients With GI Malignancies

To evaluate pain syndrome characteristics, analgesic effectiveness, opioid-related adverse events, and predictors of therapy escalation in incurable patients with GI malignancies in a resource-limited, conflict-affected setting.

A retrospective analysis of medical records of 80 incurable patients with GI tumors (colon 33.8%, pancreas 23.8%, stomach 22.5%, rectum 12.5%, liver/biliary 7.5%) treated at the Palliative Care Department of the Kyiv City Clinical Oncology Center during the period of the Russian military invasion of Ukraine (2022-2024) was performed. Pain intensity was assessed using the Verbal Rating Scale (VRS). The analgesic therapy structure, escalation needs, transition trajectories, and opioid-related adverse events were analyzed. None of the patients received concurrent oncologic treatment.

The highest pain intensity was observed in pancreatic cancer (VRS 2.68 ± 0.82), where 83.3% of patients required opioid therapy from the first day of hospitalization. Therapy escalation was needed in 23.8% of patients, most frequently with initial tramadol therapy (42.3%). Parenteral morphine demonstrated the highest effectiveness (0% escalation rate). Among nonpancreatic localizations, rectal cancer showed the highest escalation rate (40.0%) despite the lowest initial pain intensity, potentially indicating underestimated neuropathic components. Among 57 opioid-treated patients, constipation occurred in 87.7%, sedation in 43.9%, and nausea in 21.1%; all adverse events were managed with locally available medications, and no patient required opioid discontinuation.

Tumor localization determines pain intensity and analgesic strategy. Parenteral morphine provides superior pain control, and opioid-related adverse events can be effectively managed with affordable, locally available medications. These institutional observations suggest that effective opioid-based analgesia is feasible in conflict-affected, resource-constrained settings and may inform pain management approaches in other environments with disrupted health care infrastructure.