Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Palliat Med. 2013 May;16(5):516-23. doi: 10.1089/jpm.2012.0390. Epub 2013 Apr 24.
Standardized approaches for assessing and classifying cancer pain are required to improve treatment of patients with complex pain profiles. The Edmonton Classification System for Cancer Pain (ECS-CP) offers a starting point for the evolution of a standardized international classification system for cancer pain and was introduced into multisite research initiatives of the European Palliative Care Research Collaborative (EPCRC).
The primary purpose of this study was to describe the prevalence of the five ECS-CP pain classification features: pain mechanism, incident pain, psychological distress, addictive behavior, and cognition--in a diverse international sample of patients with advanced cancer.
A total of 1070 adult patients with advanced cancer were recruited from 17 sites in Norway, the United Kingdom, Austria, Germany, Switzerland, Italy, Canada, and Australia; 1051 of 1070 patients were evaluable. A clinician completed the ECS-CP for each enrolled patient. Additional information, including pain intensity, were also collected through patient self-reports, using touch-sensitive computers.
Of 1051 evaluable patients, 670 (64%) were assessed by a clinician as having cancer pain: nociceptive pain (n=534; 79.7%); neuropathic pain (n=113; 16.9%); incident pain (n=408; 60.9%); psychological distress (n=212; 31.6%); addictive behavior (n=30; 4.5%); normal cognition (n=616; 91.9%). The prevalence of ECS-CP features and pain intensity scores (11-item scale; 0=none, 10=worst; rated as now) varied substantially across sites and locations of care.
The ECS-CP is a clinically relevant systematic framework, which is able to detect differences in salient pain classification features across diverse settings and countries. Further validation studies need to be conducted in varied advanced cancer and palliative care settings to advance the development of the ECS-CP toward an internationally recognized pain classification system.
为了改善复杂疼痛患者的治疗效果，需要采用标准化方法来评估和分类癌症疼痛。埃德蒙顿癌症疼痛分类系统（ECS-CP）为建立标准化国际癌症疼痛分类系统提供了一个起点，并已被引入欧洲姑息治疗研究协作组织（EPCRC）的多站点研究计划中。
本研究的主要目的是描述在来自挪威、英国、奥地利、德国、瑞士、意大利、加拿大和澳大利亚 17 个站点的 1070 例晚期癌症患者的多样化国际样本中，五种 ECS-CP 疼痛分类特征的发生率：疼痛机制、发作性疼痛、心理困扰、成瘾行为和认知。
共招募了 1070 例晚期癌症成年患者，其中 1051 例患者可评估。每位入组患者均由临床医生完成 ECS-CP 评估。还通过触摸敏感计算机让患者进行自我报告，收集包括疼痛强度在内的其他信息。
在 1051 例可评估患者中，670 例（64%）由临床医生评估为患有癌症疼痛：伤害感受性疼痛（n=534；79.7%）；神经病理性疼痛（n=113；16.9%）；发作性疼痛（n=408；60.9%）；心理困扰（n=212；31.6%）；成瘾行为（n=30；4.5%）；正常认知（n=616；91.9%）。ECS-CP 特征和疼痛强度评分（11 项量表；0=无，10=最严重；现为）在各站点和护理地点之间差异很大。
ECS-CP 是一个具有临床意义的系统框架，能够检测到不同环境和国家之间显著疼痛分类特征的差异。需要在不同的晚期癌症和姑息治疗环境中进行进一步的验证研究，以推进 ECS-CP 向国际公认的疼痛分类系统的发展。
