{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:41:19Z","timestamp":1790624479674,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Cancer pain continues to be a major clinical problem nowadays. This study aims to evaluate the World Health Organization (WHO) analgesic ladder effectiveness in patients with colorectal cancer and develop machine learning models to predict treatment response for precision pain management. Materials and Methods: In a retrospective observational study, a total of 107 oncological patients were analyzed, with a detailed subgroup analysis of 42 patients with colorectal cancer, hospitalized between July and September in 2022. The pain assessment used numerical rating scales at baseline and 2\u20133 weeks follow-up. Clinical variables included demographics, disease staging, metastatic patterns, analgesic progression, and medication usage. Machine learning algorithms (e.g., Random Forest, CatBoost, XGBoost, and Neural Network) were used to predict pain reduction outcomes. The UMAP dimensionality reduction and clustering identified the patient phenotypes. Results: Statistical analyses included descriptive methods, Chi-square and Mann\u2013Whitney tests, and the models\u2019 performance was evaluated by AUC. Among patients with colorectal cancer, 73.8% achieved clinically pain improvement, with a mean reduction of 2.62 points and median improvement of 3.00 points. The metastatic site significantly affected outcomes: visceral metastases patients showed median improvement of 3.00 points with high variability, patients with bone metastases demonstrated heterogeneous responses (range: \u22122.00 to +8.00 points), while non-metastatic patients exhibited consistent improvement. Random Forest achieved optimal predictive performance (AUC: 0.9167), identifying the baseline pain score, bone metastases, Fentanyl usage, anticonvulsants, and antispasmodics as key predictive features. The clustering analysis revealed two distinct phenotypes, requiring different analgesic intensities. Conclusions: This study validates the WHO analgesic ladder effectiveness while demonstrating superior outcomes in patients with colorectal cancer. The machine learning models successfully predict the treatment response with excellent discriminative ability, supporting precision medicine implementation in cancer pain management.<\/jats:p>","DOI":"10.3390\/medicina61101741","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T07:46:49Z","timestamp":1758786409000},"page":"1741","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Modeling Pain Dynamics and Opioid Response in Oncology Inpatients: A Retrospective Study with Application to AI-Guided Analgesic Strategies in Colorectal Cancer"],"prefix":"10.3390","volume":"61","author":[{"given":"Eliza-Maria","family":"Froicu (Armeanu)","sequence":"first","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Internal Medicine Department, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana-Maria","family":"Onicescu (Oniciuc)","sequence":"additional","affiliation":[{"name":"Faculty of Computer Science, \u201cAlexandru Ioan Cuza\u201d University, 700506 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2631-7458","authenticated-orcid":false,"given":"Ioana","family":"Creang\u0103-Murariu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"},{"name":"Advanced Center for Research and Development in Experimental Medicine \u201cProf. Ostin C. Mungiu\u201d, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia","family":"Dasc\u0103lu","sequence":"additional","affiliation":[{"name":"Advanced Center for Research and Development in Experimental Medicine \u201cProf. Ostin C. Mungiu\u201d, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Pharmacology, Clinical Pharmacology and Algesiology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2923-3567","authenticated-orcid":false,"given":"Bogdan","family":"Gafton","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad-Adrian","family":"Afr\u0103s\u00e2nie","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-9568","authenticated-orcid":false,"given":"Teodora","family":"Alexa-Stratulat","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"},{"name":"Advanced Center for Research and Development in Experimental Medicine \u201cProf. Ostin C. Mungiu\u201d, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai-Vasile","family":"Marinca","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana-Maria","family":"Pu\u0219ca\u0219u","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"},{"name":"Department of Medical Genetics, Faculty of Medicine, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian","family":"Miron","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Medical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2793-3495","authenticated-orcid":false,"given":"Gema","family":"Bacoanu","sequence":"additional","affiliation":[{"name":"2nd Internal Medicine Department, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi, 700115 Ia\u0219i, Romania"},{"name":"Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Afr\u0103s\u00e2nie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2503-5395","authenticated-orcid":false,"given":"Vladimir","family":"Poroch","sequence":"additional","affiliation":[{"name":"2nd Internal Medicine Department, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi, 700115 Ia\u0219i, Romania"},{"name":"Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","first-page":"CD011129","article-title":"Early palliative care for adults with advanced cancer","volume":"6","author":"Haun","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"515","DOI":"10.2147\/JPR.S97759","article-title":"Effectiveness of the World Health Organization cancer pain relief guidelines: An integrative review","volume":"9","author":"Carlson","year":"2016","journal-title":"J. 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