Which domains should be included in a cancer pain classification system? Analyses of longitudinal data

Abstract

The overall aim of the present study was to further develop an evidence-based platform for the content of an international cancer pain classification system. Data from a multicentre, observational longitudinal study of cancer patients were analysed. Analyses were carried out in 2 samples: (A) Cross-sectional data of patients on opioids at inclusion, and (B) patients just admitted to palliative care. Outcome measures in the models we investigated were pain on average, worst pain, and pain relief at inclusion, and at day 14, respectively. Uni- and multivariate regression models were applied to test the explicative power on pain outcomes of a series of known pain domains, including incident pain, psychological distress, neuropathic pain, pain localisation, sleep disturbances, total morphine equivalent daily dose (MEDD), and cancer diagnosis. In the 2 analyses, 1529 (A) and 352 (B) patients were included, respectively. Incident pain, pain localisation, MEDD, use of nonsteroidal antiinflammatory drugs, and sleep were associated with one or more of the pain outcomes in analysis A, while initial pain intensity, initial pain relief, incident pain, localisation of pain, cancer diagnosis, and age were predictors in the longitudinal analysis. Identified domains explained 16% to 24% of the variability of the pain outcome. Initial pain intensity emerged as the strongest predictor of pain outcome after 2 weeks, and incident pain was confirmed to be a relevant domain. The regression models explained only a minor part of the variability of pain outcomes.

From “Breakthrough” to “Episodic” Cancer Pain? A European Association for Palliative Care Research Network Expert Delphi Survey Toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations

“…Factors other than differences in symptom and disease burden might influence the reported prevalence. These factors include differences in definitions and diagnostic criteria (3,4), and inclusion of patients with poorly controlled background pain (5). …”

Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart

“…To evaluate pain, localization, pain intensity, breakthrough pain (BTP), neuropathic pain, and depressive symptoms has been recommended as a minimum (6). For evaluation of these domains, different assessment tools are available, such as the Edmonton Classification System for Cancer Pain (ESC-CP) (7), the Brief Pain Inventory (BPI) (8), the Leeds assessment of Neuropathic Symptoms and Signs (LANSS) (9), and the Patient Health Questionnaire (PHQ) 9 (10,11).…”

“…BTP is present in 40%-80% of cancer patients with pain (14) and has been associated with increased pain intensity, psychological distress, sleep disturbance, longer time to achieve pain control and as a predictor of more complex pain (6,7,15,16). Despite that classification, assessment and treatment of BTP are fundamental in cancer pain management; still no consensus is achieved on a common definition of BTP or an international recommendation for which assessment tool to use (17).…”

Minimally invasive procedures for the management of vertebral bone pain due to cancer: The EAPC recommendations

“…Until then, the balance of evidence favors the use of these procedures in a small select cohort of patients with severe and disabling back pain refractory to medical therapy. Studies should assess how these techniques can specifically improve incident bone pain, which is one of the most important negative predictors of pain outcome [32]. …”