Expert conference on cancer pain assessment and classification—the need for international consensus: working proposals on international standards

Abstract

An increasing number of cancer patients live longer, and palliative care has become an important part of their treatment. Symptoms are often inadequately assessed and managed. A significant challenge in clinical trials is to control for the variability of the samples being studied. To overcome this problem, classification systems have been developed in order to characterise and stratify patients by grouping them according to major common characteristics. The lack of agreed methods for the assessment and classification of cancer pain has been clearly indicated in clinical trials and in clinical practice and may be one possible explanation for the inadequate treatment of cancer pain. This was the background to an international expert meeting arranged in September 2009 in Milan, Italy. The primary aims were to produce recommendations on how to assess and classify cancer pain and to recommend a strategy for the further development, validation and implementation of an international cancer pain classification and assessment system. The recommendations consisted of two basic working proposals, nine specific working proposals and seven recommendations for the further development of a cancer pain classification system. Examples of specific working proposals were to include pain intensity, pain mechanism, breakthrough pain and psychological distress as the core domains in this classification of cancer pain and to measure pain intensity with a 0-10 numerical rating scale with 'no pain' and 'pain as bad as you can imagine' as anchors. The proposed name for this international standard is Cancer Pain Assessment and Classification System (CPACS).

Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer

“…Although a time frame of 1 week stood out as the strongest predictor, we strongly believe that high PI regardless of time window should prompt clinicians to perform a more in-depth pain assessment and re-evaluate the pain management, including the use of antitumour measures such as palliative radiotherapy. The measure of PI, supplemented by a multidimensional assessment, is the gold standard to guide pain management, in line with recommendations defining PI, pain relief and temporal pattern of pain as the most relevant outcomes in clinical practice 13. Associations between high PI and BTP have also been documented by others,8 31 32 and it is highly likely that the high pain levels also reflect BTP episodes.…”

“…An Expert Working Group of the European Association for Palliative Care (EAPC)11 has recommended the use of multidimensional tools, such as the Brief Pain Inventory—Short Form (BPI-SF),12 to promote a standardised approach to pain assessment in advanced cancer, in line with later proposals 13…”

Classification of neuropathic pain in cancer patients

“…Assessment and classification of pain should be a fundamental part of the management to control cancer pain [21].…”

Impact of admission to hospice on pain intensity and type of pain therapies administered

“…Assessment and treatment represent the two main steps for the management of cancer pain [4]. Although numerous aspects of pain can be assessed, pain intensity is generally considered as the Bbasic^parameter to be evaluated [5,6]. Daily assessment in the form of an informal interview with patients provides a valid indication of the level of pain and may take into account the pain experienced in the previous 24 h (worst, least, and average) or Bpain right now^.…”