An international multicentre validation study of a pain classification system for cancer patients

University of Alberta, Edmonton, Canada.
European journal of cancer (Oxford, England: 1990) (Impact Factor: 5.42). 11/2010; 46(16):2896-904. DOI: 10.1016/j.ejca.2010.04.017
Source: PubMed


The study's primary objective was to assess predictive validity of the Edmonton Classification System for Cancer Pain (ECS-CP) in a diverse international sample of advanced cancer patients. We hypothesised that patients with problematic pain syndromes would require more time to achieve stable pain control, more complicated analgesic regimens and higher opioid doses than patients with less complex pain syndromes.
Patients with advanced cancer (n=1100) were recruited from 11 palliative care sites in Canada, USA, Ireland, Israel, Australia and New Zealand (100 per site). Palliative care specialists completed the ECS-CP for each patient. Daily patient pain ratings, number of breakthrough pain doses, types of pain adjuvants and opioid consumption were recorded until study end-point (i.e. stable pain control, discharge and death).
A pain syndrome was present in 944/1100 (86%). In univariate analysis, younger age, neuropathic pain, incident pain, psychological distress, addictive behaviour and initial pain intensity were significantly associated with more days to achieve stable pain control. In multivariate analysis, younger age, neuropathic pain, incident pain, psychological distress and pain intensity were independently associated with days to achieve stable pain control. Patients with neuropathic pain, incident pain, psychological distress or higher pain intensity required more adjuvants and higher final opioid doses; those with addictive behaviour required only higher final opioid doses. Cognitive deficit was associated with fewer days to stable pain control, lower final opioid doses and fewer pain adjuvants.
The replication of previous findings suggests that the ECS-CP can predict pain complexity in a range of practice settings and countries.

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    • "Neuropathic pain (NP) is a core domain in the classification of cancer patients with pain [8] [15] [22] [23]. It is associated with a worse response to conventional analgesic treatment [12,22–24] and can be relieved by specific adjuvant drugs enhancing the efficacy of opioid analgesia [5] [9]. "
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    ABSTRACT: Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the NeuPSIG criteria to the diagnosis of NP in cancer patients and on the relevance of patient reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified two-round internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, standardized PRO assessment for NP screening. Median consensus scores (MED) and inter-quartile ranges (IQR), were calculated to measure expert consensus after both rounds. 29 experts answered and good agreement was found on the statement "the pathophysiology of NP due to cancer can be different from non-cancer NP" (MED=9, IQR=2). Satisfactory consensus was reached for the first three NeuPSIG criteria (pain distribution, history and sensory findings) (MEDs>=8, IQRs<=3), but not for the fourth one (diagnostic test/imaging) (MED=6, IQR=3). Agreement was also reached on clinical examination by soft brush or pin stimulation (MEDs>=7 and IQRs<=3) and on the use of PRO descriptors for NP screening (MED=8, IQR=3). Based on the study results a clinical algorithm for NP diagnostic criteria in cancer patients with pain was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients.
    Full-text · Article · Oct 2014 · Pain
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    • "The original version categorised cancer pain as ''nociceptive ,'' ''neuropathic,'' ''mixed,'' and ''unclassified'' [11]. The updated version has reduced the classification to a dichotomous yes/no response to denote the presence or absence of NP based on the clinician opinion [10]. There is clearly uncertainty surrounding the classification and diagnosis of NP in cancer patients. "

    Full-text · Article · Nov 2013 · Pain
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    • "In another 10 studies, the primary aim was to evaluate the aetiology of pain in cancer patients [1,9,11,17,25,30,31,33–35]. Assessment of verbal pain description or the performance of screening tools to discriminate between types of pain was the primary aim in another 5 studies [13] [26] [27] [29] [36]. Finally, 1 paper was a controlled , single-dose study that assessed response to opioids on the basis of pain type [10] "
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    ABSTRACT: Pain in cancer patients remains common and is often associated with insufficient prescribing of targeted analgesia. An explanation for undertreatment could be the failure to identify neuropathic pain mechanisms, which require additional prescribing strategies. We wanted to identify the prevalence of neuropathic mechanisms in patients with cancer pain to highlight the need for detailed assessment and to support the development of an international classification system for cancer pain. We searched for studies that included adult and teenage patients (age above 12 years), with active cancer and who reported pain, and in which a clinical assessment of their pain had been made. We found 22 eligible studies that reported on 13,683 patients. Clinical assessment methods varied, and only 14 studies reported confirmatory testing for either sensory abnormality or diagnostic lesion to corroborate a diagnosis of neuropathic pain. We calculated that the prevalence of patients with neuropathic pain (95% confidence interval) varied from a conservative estimate of 19% (9.4% to 28.4%) to a liberal estimate of 39.1% (28.9% to 49.5%) when patients with mixed pain were included. The prevalence of pain with a neuropathic mechanism (95% confidence interval) ranged from a conservative estimate of 18.7% (15.3% to 22.1%) to a liberal estimate of 21.4% (15.2% to 27.6%) of all recorded cancer pains. The proportion of pain caused by cancer treatment was higher in neuropathic pain compared with all types of cancer pain. A standardised approach or taxonomy used for assessing neuropathic pain in patients with cancer is needed to improve treatment outcomes.
    Full-text · Article · Nov 2011 · Pain
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