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Risks factors for severe pain after selective liver transarterial chemoembolization
Author(s) -
Benzakoun Joseph,
Ronot Maxime,
Lagadec Matthieu,
Allaham Wassim,
Garcia Alba Carmela,
Sibert Annie,
Vilgrain Valérie
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13235
Subject(s) - medicine , hepatocellular carcinoma , logistic regression , chronic liver disease , gastroenterology , multivariate analysis , opioid , univariate analysis , liver disease , abdominal pain , chronic pain , cirrhosis , physical therapy , receptor
Background & Aims Post‐procedural pain is frequent after transarterial chemoembolization ( TACE ) for hepatocellular carcinoma ( HCC ), and is only partially prevented by treatment selectivity. Our aim was to determine the risk factors of severe pain after selective TACE for HCC . Methods From January 2012 to June 2014, all treatment‐naïve patients undergoing a first selective TACE were included. Risk factors for severe pain, that is, the need for opioid analgesics (grade II – III ), were identified by uni‐ and multivariate analysis. Internal validation of a logistic regression model for prediction of opioid intake was done with bootstrapping. Results We analysed 335 tumours (mean 47 ± 37 mm) in 159 patients (131 men), mean 63.4 years old (20–92). Twenty‐seven patients (17%) requested opioids. In univariate analysis, opioid intake was associated with young age ( P =.021), doxorubicin dose received ( P =.031), large HCC ( P =.038), absence of chronic liver disease ( P <.001) and alpha‐foetoprotein levels ( P =.03). In multivariate analysis, opioid intake was associated with young age ( OR =0.65 per 10 years increment, P =.048), absence of chronic liver disease ( OR =31.7, P <.001) and a higher fraction of the doxorubicin dose ( OR =1.32 per 10% increment, P =.009). The optimism‐corrected area under the curve of the prediction model for opioid intake using these three factors was 0.751. Conclusion In patients with HCC treated with TACE , selective procedure does not always prevent from severe pain. Young patients without chronic liver disease may be more susceptible to severe pain.