University of Alberta, Edmonton, Canada.
Eur J Cancer. 2010 Nov;46(16):2896-904. doi: 10.1016/j.ejca.2010.04.017. Epub 2010 May 17.
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.
本研究的主要目的是评估埃德蒙顿癌症疼痛分类系统（ECS-CP）在来自不同国家和地区的晚期癌症患者中的预测效度。我们假设，具有复杂疼痛综合征的患者需要更多的时间来实现稳定的疼痛控制，更复杂的镇痛方案和更高剂量的阿片类药物，而疼痛综合征相对简单的患者则需要较少的时间。
从加拿大、美国、爱尔兰、以色列、澳大利亚和新西兰的 11 个姑息治疗中心（每个中心 100 名患者）招募了 1100 名患有晚期癌症的患者。姑息治疗专家为每位患者填写 ECS-CP。记录患者每日疼痛评分、爆发性疼痛剂量、辅助性镇痛药类型和阿片类药物的消耗情况，直到研究终点（即稳定的疼痛控制、出院和死亡）。
1100 名患者中有 944 名（86%）存在疼痛综合征。单因素分析显示，年龄较小、神经病理性疼痛、新发疼痛、心理困扰、成瘾行为和初始疼痛强度与达到稳定疼痛控制所需的天数显著相关。多因素分析显示，年龄较小、神经病理性疼痛、新发疼痛、心理困扰和疼痛强度与达到稳定疼痛控制所需的天数独立相关。患有神经病理性疼痛、新发疼痛、心理困扰或更高疼痛强度的患者需要更多的辅助药物和更高的最终阿片类药物剂量；具有成瘾行为的患者仅需要更高的最终阿片类药物剂量。认知障碍与达到稳定疼痛控制的天数较少、最终阿片类药物剂量较低和辅助性镇痛药较少有关。
这些发现的重复表明，ECS-CP 可以在各种实践环境和国家预测疼痛的复杂性。
