Classification of neuropathic pain in cancer patients: A Delphi expert survey report and EAPC/IASP proposal of an algorithm for diagnostic criteria

Abstract

Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the International Association for the Study of Pain (IASP) special interest group for neuropathic pain (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 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine 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 3 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.

Cancer Pain With a Neuropathic Component: A Cross-sectional Study of Its Clinical Characteristics, Associated Psychological Distress, Treatments, and Predictors at Referral to a Cancer Pain Clinic

“…15 Although there has been a relative preponderance of neuropathic pain studies in the noncancer chronic pain populations, the generalizability of their findings to the cancer pain population has limitations. 16 An improved understanding and characterization of the clinical presentation of neuropathic cancer pain is, therefore, an important step in advancing its assessment and management. Furthermore, there are few reported data regarding cancer pain in Portuguese cancer care settings.…”

The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

“…The resulting knowledge synthesis will guide therapeutic intervention strategies in cancer pain management and thereby optimize health-related quality of life. • Evaluate use of standardized criteria such as the NeuPSIG guidelines or algorithm; [49,52] • Consensus (Delphi process and surveys) on the standardized operationalization of domain assessments, particularly psychological distr ess and incident pain;…”

“…This suggests that screening with a validated tool may improve the sensitivity of neuropathic pain detection, as demonstrated in cancer pain studies with the Leeds Assessment of Neuropathic Pain Scale in Australia and the DN4 in Portugal [50,51]. Also, use of formal guidelines, such as the NeuPSIG guidelines or a standardized algorithm based on NeuPSIG criteria is likely to improve the accuracy of neuropathic pain diagnosis when compared to non-standardized clinical assessment [49,52].…”

“…Pain is one of the most feared and distressing symptoms associated with cancer. Pooled prevalence estimates suggest that 55% (95% confidence interval, [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] of patients receiving active cancer treatment and 64% (58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75) of those with advanced disease experience cancer pain [1]. Cancer is associated with ageing [2], and given current demographic trends that signal a dramatic increase in the elderly proportion of the population [3], an informed approach to cancer pain assessment and management is of great importance.…”

Classification of neuropathic pain in cancer patients

“…Four specific criteria used are summarised in Table 1 A recent Delphi survey about the use and adaptation of the NeuPSIG criteria for NP diagnosis to be applied in cancer patients was conducted where an international group of 29 experts participated; the results showed experts agreed on criteria 1-3 of the NeuPSIG, whereas for the fourth criteria (confirmation of lesion affecting the somatosensory system from diagnostic test or imaging) experts suggested that a distinction had to be made whether history and existing exams could explain the cause of the pain [14]. We have combined these recommendations to outline a clinically relevant process to classify NP.…”