Journal of liver cancer · 2026
Pain, analgesic use and misconceptions in patients with hepatocellular carcinoma: a cross-sectional survey.
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Park Jina, Yang Jiwon, Chung Sung Won, Choi Won-Mook, Shim Ju Hyun, Lee Danbi, Kim Kang Mo, Lim Young-Suk, Lee Han Chu, Choi Jonggi
Аннотация
BACKGROUND/AIMS: Cancer-related pain remains undertreated despite established guidelines. In hepatocellular carcinoma (HCC), underlying chronic liver disease may amplify concerns regarding analgesic safety. We aimed to evaluate pain prevalence, analgesic use, pain-related perceptions, and educational needs among patients with HCC.
METHODS: We conducted a cross-sectional survey of 200 adult patients with HCC receiving systemic therapy at a tertiary referral center. A 30-item questionnaire assessed pain presence and intensity using a numeric rating scale (NRS), analgesic use patterns, liver-related safety concerns, opioid-related stigma, and educational needs. Clinical characteristics, including tumor burden and liver function, were analyzed in relation to pain and perception domains.
RESULTS: Fifty-five patients (27.5%) reported current pain (mean NRS, 3.6 ± 2.5; mean worst pain 5.2 ± 2.8). Among them, 31 (56.3%) were using analgesics; however, 51.6% reported using them only when pain became unbearable. Misconceptions regarding analgesic safety were prevalent: 70.0% believed long-term analgesic use damages the liver, 56.0% believed analgesics are unsafe with impaired liver function, 46.5% associated opioids with addiction, and 30.0% hesitated due to the term "narcotic". These beliefs were not associated with Child-Pugh class or serum albumin level. Extrahepatic metastasis was associated with higher liver-related concern scores and a trend toward increased pain prevalence. Patients with elementary school education or less had poorer pain scale knowledge and no prior counseling.
CONCLUSIONS: Pain undertreatment and safety-related misconceptions are common in HCC and appear independent of objective liver function. Structured, proactive education-particularly for patients with untreated pain and low educational attainment-may improve pain control in this population.
METHODS: We conducted a cross-sectional survey of 200 adult patients with HCC receiving systemic therapy at a tertiary referral center. A 30-item questionnaire assessed pain presence and intensity using a numeric rating scale (NRS), analgesic use patterns, liver-related safety concerns, opioid-related stigma, and educational needs. Clinical characteristics, including tumor burden and liver function, were analyzed in relation to pain and perception domains.
RESULTS: Fifty-five patients (27.5%) reported current pain (mean NRS, 3.6 ± 2.5; mean worst pain 5.2 ± 2.8). Among them, 31 (56.3%) were using analgesics; however, 51.6% reported using them only when pain became unbearable. Misconceptions regarding analgesic safety were prevalent: 70.0% believed long-term analgesic use damages the liver, 56.0% believed analgesics are unsafe with impaired liver function, 46.5% associated opioids with addiction, and 30.0% hesitated due to the term "narcotic". These beliefs were not associated with Child-Pugh class or serum albumin level. Extrahepatic metastasis was associated with higher liver-related concern scores and a trend toward increased pain prevalence. Patients with elementary school education or less had poorer pain scale knowledge and no prior counseling.
CONCLUSIONS: Pain undertreatment and safety-related misconceptions are common in HCC and appear independent of objective liver function. Structured, proactive education-particularly for patients with untreated pain and low educational attainment-may improve pain control in this population.