Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
University of Oslo, Oslo, Norway.
Pain. 2021 Mar 1;162(3):866-874. doi: 10.1097/j.pain.0000000000002076.
Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.
神经性癌症疼痛（NcP）与较差的治疗反应和特定的治疗指征相关，但仍缺乏标准化的临床 NcP 诊断。这是一项针对门诊癌症患者的前瞻性观察性研究，比较了不同的临床方法与 NcP 评估。使用 DN4（截断值为 4）、姑息治疗医师的临床印象，包括病因和疼痛综合征识别，以及由专家委员会进行回顾性临床分类，对 NcP 进行了三步评估，该委员会采用了国际疼痛研究协会（IASP）神经病理性疼痛特别兴趣小组的标准。神经性癌症疼痛分类特指直接由癌症引起的疼痛。共评估了 350 名患者，DN4、临床印象和回顾性临床分类分别显示 NcP 的患病率为 20%（95%置信区间 [CI] 15.9%-24.6%）、36.9%（95% CI 31.6%-42.1%）和 28.6%（95% CI 23.8%-33.9%）。DN4 与回顾性临床分类之间的 Cohen's kappa 一致性系数为 0.57（95% CI 0.47-0.67），表明中度一致性。对于特定的疼痛综合征，如深部软组织浸润引起的疼痛和与直肠痉挛相关的疼痛，发现了更高比例的不相符。临床医生之间的意见分歧也导致了不同的 NcP 诊断，并强调了缺乏同质的临床标准。严格应用病因和综合征诊断来解释疼痛原因，并结合标准化的诊断标准和评估疼痛特征，这对于癌症疼痛状况也是特异性的，可能会改善 NcP 的临床分类。
