SYSTEMATIC REVIEW article

Front. Neurol.

Sec. Headache and Neurogenic Pain

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1517279

This article is part of the Research TopicInnovative Approaches to Neuralgia: Mechanisms and Treatment DevelopmentView all 10 articles

Risk Factors and Clinical Significance of Refractory Pain in Patients with Bone Metastases: A Comprehensive Meta-Analysis

Provisionally accepted
Qiju  LiQiju Li1Qingqing  LiuQingqing Liu1Liu  YangLiu Yang1Qin  LiQin Li2Aimin  ZhangAimin Zhang2*
  • 1Chengdu Xinhua HospitalAffiliated to North Sichuan Medical College, Chengdu, China
  • 2Sichuan Cancer Hospital, Chengdu, China

The final, formatted version of the article will be published soon.

Background: Refractory cancer pain, especially bone pain, presents a major clinical challenge that is difficult to manage despite the use of multimodal analgesic strategies. This meta-analysis aims to estimate the prevalence of refractory cancer pain in this patient population and to identify potential predictors that may increase the likelihood of developing such pain.In addition, we performed a systematic review of previous studies that delve into more effective pain strategies.Methods: This meta-analysis and systematic review were conducted in accordance with the PRISMA guidelines. A comprehensive search was performed using PubMed,Web of Science, Embase, and the Cochrane Library on risk factors for refractory metastatic bone pain. The inclusion criteria focused on studies reporting the incidence and/or risk factors associated with refractory cancer pain, providing relevant statistical measures such as odds ratios (OR), hazard ratios (HR), or relative risks (RR). The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS), and a random-effects meta-analysis was conducted using the R programming language.Results: The present study included eight studies with a cumulative sample size of 2,774 patients. The aggregated incidence of refractory cancer pain was found to be 70% (95% confidence interval [CI]: 42% to 88%) using a random-effects model, highlighting a significant prevalence of pain that remains unresponsive to treatment. Notably, the heterogeneity among the included studies was considerable (I² = 98%, τ² = 2.7198). The analysis also identified several critical predictors of refractory cancer pain. The presence of multiple bone metastases was consistently linked to an increased likelihood of refractory cancer pain with an OR of 3.94 (95% CI: 2.64-5.87). Similarly, lytic bone metastases demonstrated a high OR of 5.99 (95% CI: 3.17-11.30). Furthermore, there was a strong correlation between the occurrence of refractory cancer pain with severe acute pain (OR = 219.20, 95% CI: 0.26-188127.63), breakthrough pain (OR = 16.44, 95% CI: 0.60-448.07), and psychological comorbidities such as depression (OR = 3.91,

Keywords: Refractory cancer pain, Bone Metastases, Risk factors, Meta-analysis, Incidence, Pain Management

Received: 25 Oct 2024; Accepted: 28 Mar 2025.

Copyright: © 2025 Li, Liu, Yang, Li and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Aimin Zhang, Sichuan Cancer Hospital, Chengdu, China

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