A cross-sectional, comparative, syndromic description of oncological mixed pain in Medical Oncology units in Spain

  • Santiago PonceEmail author
  • Ana Yuste
  • Ana Esquivias
  • Ana Leal
  • Jesús Villoria
Original Article



The reason cancer pain remains prevalent and hard to classify may be partially explained by the failure to identify neuropathic mechanisms. The objective of this research was to identify the syndromes of cancer pain that may be particularly hard to manage due to their mixed pathophysiology.


A series of 384 patients who had cancer of any type, at any stage, and suffered from chronic pain (symptom onset > 3 months) were assessed during a routine return visit in Spain. Medical oncologists indicated the presence and pathophysiology of 33 predefined pain syndromes on a per-patient basis. This information was then measured against clinical, psychosocial, and health care-related data to determine which syndromes pose particular challenges.


The mean (standard deviation) age of patients was 61.6 (12.6) years, 49.7% were women. Most (82%) had advanced metastatic disease, 68.7% were on second-line or palliative therapies. The worst syndrome was nociceptive, pure neuropathic, and mixed in 34.6, 26.9, and 38.6% of patients, respectively. Any syndrome could be of mixed pathophysiology. Only 10 syndromes were common (≥ 5% of patients). Syndromes related to malignant bone pain and involvement of chest wall structures were the most frequent. Certain syndromes (including tumor-related bone pain, chemotherapy-induced peripheral neuropathies, paraneoplastic pain syndromes, and malignant neuralgias or injury to cranial nerves) can be particularly challenging when they have a mixed pathophysiology, because the neuropathic component is rarely or unevenly considered.


Virtually all cancer pain syndromes can present mixed pathophysiology. Certain syndromes can include neuropathic components that are frequently overlooked.


Cancer Classification Chronic pain Neoplasms Neuralgia Pathophysiology 



The authors wish to thank all the clinical investigators for their contribution to this study in recruiting, assessing, and providing the data from the patients. The authors acknowledge the contribution made by Raquel Jerez (Biostatistician) during the statistical analysis of the data. Authors wish also to thank patients who consented to participate and release their personal data for the scientific purposes of this research.

Author contributions

Santiago Ponce developed the protocol, performed clinical evaluations of patients, and supervised the study.

Ana Yuste was the top recruiter and performed clinical evaluations.

Ana Esquivias and Ana Leal developed the protocol and coordinated the study.

Jesús Villoria participated in protocol development, designed and performed the analysis of data, and drafted the manuscript.

All authors participated in the review and extraction of literature, the design of the study, the interpretation of results, and the preparation of the manuscript. All authors had full access to the data and have provided their final approval to the manuscript for publication.


This research has been funded by Grünenthal Pharma, S.A. Grünenthal Pharma, S.A. did not have any direct corporate role in the design, analysis, and interpretation of results, or preparation of the manuscript.

Compliance with ethical standards

Competing interests

Authors received funds from Grünenthal Pharma, S.A. for this research.

Santiago Ponce and Ana Yuste have no competing interests to declare.

Ana Esquivias and Ana Leal have a full time position at Grünenthal Pharma, S.A.

Jesús Villoria has received honoraria for drafting manuscripts for Grünenthal Pharma, Mundipharma, and Esteve and receives consultancy fees from Grünenthal Pharma, Lilly, Novartis, Esteve, Amadix, and Vivia Biotech.

Ethical approval

The study was performed in accordance with the updated Declaration of Helsinki. The Ethics Committee of the Hospital Doce de Octubre in Madrid approved the study protocol prior to start.

Informed consent

All patients provided a written informed consent to participate.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Santiago Ponce
    • 1
    Email author
  • Ana Yuste
    • 2
  • Ana Esquivias
    • 3
  • Ana Leal
    • 3
  • Jesús Villoria
    • 4
  1. 1.Spanish National Cancer Research CenterUniversity Hospital “Doce de Octubre”MadridSpain
  2. 2.Medical Oncology DepartmentHospital General Universitario de AlicanteAlicanteSpain
  3. 3.Medical DepartmentGrünenthal Pharma SAMadridSpain
  4. 4.Department of Statistical Design and BiometricsMedicxact SLAlpedreteSpain

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