Fainsinger Robin L, Nekolaichuk Cheryl L
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada.
Support Care Cancer. 2008 Jun;16(6):547-55. doi: 10.1007/s00520-008-0423-3. Epub 2008 Mar 4.
The purpose of this paper is to provide an overview of the development of a "TNM" cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat.
In response to this gap in clinical assessment, the Edmonton Staging System (ESS), a classification system for cancer pain, was developed. Difficulties in definitions and interpretation of some aspects of the ESS restricted acceptance and widespread use.
Construct, inter-rater reliability, and predictive validity evidence have contributed to the development of the ECS-CP. The five features of the ECS-CP--Pain Mechanism, Incident Pain, Psychological Distress, Addictive Behavior and Cognitive Function--have demonstrated value in predicting pain management complexity.
The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.
本文旨在概述一种针对晚期癌症患者的“TNM”癌症疼痛分类系统——埃德蒙顿癌症疼痛分类系统（ECS-CP）的发展情况。在我们拥有一种讨论癌症疼痛的通用国际语言之前，理解阿片类药物轮换和使用方面临床及研究经验的差异仍存在问题。癌症疼痛体验的复杂性给疼痛分类带来了独特挑战。迄今为止，尚无一种被普遍接受的疼痛分类方法能够准确预测疼痛管理的复杂性，尤其是对于难以治疗的癌症疼痛患者。
为应对临床评估中的这一空白，开发了一种癌症疼痛分类系统——埃德蒙顿分期系统（ESS）。ESS某些方面在定义和解释上的困难限制了其被接受程度和广泛应用。
结构效度、评分者间信度和预测效度证据推动了ECS-CP的发展。ECS-CP的五个特征——疼痛机制、突发性疼痛、心理困扰、成瘾行为和认知功能——在预测疼痛管理复杂性方面已显示出价值。
开发一种全面、具有预后性且易于使用的标准化分类系统可为癌症疼痛的临床管理和研究提供一种通用语言。一项评估ECS-CP评分者间信度和预测价值的国际研究正在进行中。
