2663 - Impact of Pain Management Interventions and Radiation Therapy on Pain Control and Treatment Accuracy in Spine Radiation for Metastasis

08:00am - 09:00am PT

Hall F

Screen: 23

POSTER

Presenter(s)

Sybil Jones, MD - Memorial Sloan Kettering Cancer Center, New York, NY

S. T. Jones¹, E. Jones², C. B. Jackson³, A. J. Abaya⁴, M. Gil⁴, D. S. Higginson³, N. Rakesh³, Y. Yamada⁴, A. Gulati³, and D. Yerramilli⁴; ¹Geisel School of Medicine, Dartmouth College, Hanover, NH, ²Mount Sinai Hospital, New York, NY, ³Memorial Sloan Kettering Cancer Center, New York, NY, ⁴Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): Patients undergoing spine radiation often experience severe pain, which can impair treatment positioning, cause intrafraction movement, and increase risk to nearby structures like the spinal cord, esophagus, and small bowel. This study evaluates whether pre-radiation pain interventions, such as epidural steroid injections, joint injections, or nerve blocks, reduce cone beam CT (CBCT) shifts and patient-reported pain

Materials/Methods: This retrospective cohort study analyzed 315 patients who received spine SBRT (Dec 2021–Sept 2023), stratified by pre-treatment pain interventions within six months. Data included demographics, spinal level involvement, treated levels, fractions planned, CBCT shifts (average, median, and dimensions), and pain intervention type. For those receiving interventions, patient-reported Pain, Enjoyment of Life, and General Activity (PEG) scores were assessed pre-procedure, post-procedure, and post-radiation. Statistical analysis used Wilcoxon Rank-Sum for continuous and Chi-square for categorical variables.

Results: Among 315 patients, 27 received pain management interventions, while 288 did not. For those that received a pain management intervention, PEG scores declined stepwise: median total PEG scores among the 27 patients decreased by 2.5 points from 6.0 pre-pain procedure to 3.5 post-pain procedure, and further decreased by 0.5 points after radiation therapy, with a post-radiation median PEG score of 3.0.PEG scores decreased across all domains: average pain (-3.0), enjoyment of life (-2.0), and general activity (-2.0) from pre- to post-procedure.

There was an average of 1.62 CBCT shifts per person per fraction for those who underwent a pain management intervention and 1.46 for those who did not (p = 0.35). There were no significant detected differences in individual dimensions shifts between the pain intervention and non-intervention groups.

Conclusion: Pain management interventions were associated with notable pain relief across all three domains of the PEG score, and radiation therapy provided an additional decrease in pain levels. The stepwise reduction in PEG scores suggests that integrating pain management prior to radiotherapy may optimize pain control and decrease movement on the radiation table. Considering these interventions generally have a minimal side effect profile, they represent a well-tolerated strategy to improve patient comfort during treatment. This study was retrospective and therefore is likely confounded by indication, with patients experiencing higher baseline levels of pain being more likely to receive pain interventions. Prospective collection of PEG scores, and randomized studies are needed to assess the clinical impact of pain interventions on treatment accuracy.