Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
J Palliat Med. 2023 Mar;26(3):366-375. doi: 10.1089/jpm.2022.0187. Epub 2022 Oct 25.
The goal of the Edmonton Classification System for Cancer Pain (ECS-CP) is to create an international classification system for cancer pain. Previous studies reinforce the need for standardized training to ensure consistency across assessors. There is no universally accepted classification for neuropathic pain. Our primary objective was to describe the prevalence of ECS-CP features in a diverse sample of advanced cancer patients, using assessors with standardized training. The secondary objectives were to: (1) determine the prevalence of neuropathic pain using the Neuropathic Pain Special Interest Group (NeuPSIG) criteria and (2) examine the relationship between specific predictors: ECS-CP features, age, Palliative Performance Scale, Morphine Equivalent Daily Dose (MEDD), setting, and pain intensity; and neuropathic pain. A total of 1050 adult patients with advanced cancer were recruited from 11 Canadian sites. A clinician completed the ECS-CP and NeuPSIG criteria, and collected additional information including demographics and pain intensity (now). All assessors received standardized training. Of 1050 evaluable patients, 910 (87%) had cancer pain: nociceptive ( = 626; 68.8%); neuropathic ( = 227; 24.9%); incident ( = 329; 36.2%); psychological distress ( = 209; 23%); addictive behavior ( = 51; 5.6%); and normal cognition ( = 639; 70.2%). The frequencies of ECS-CP features and pain intensity scores varied across sites and settings, with more acute settings having higher frequencies of complex pain features. The overall frequency of neuropathic pain was 24.9%, ranging from 11% (hospices) to 34.2% (palliative outpatient clinic) across settings. Multivariate logistic regression analysis revealed that age <60 years, MEDD ≥19 mg, pain intensity ≥7/10, and incident pain were significant independent predictors of neuropathic pain ( < 0.05). The ECS-CP was able to detect salient pain features across settings. Furthermore, the frequencies of neuropathic pain utilizing the NeuPSIG criteria fits within the lower-end of literature estimates (13%-40%). Further research is warranted to validate the NeuPSIG criteria in cancer pain.
埃德蒙顿癌症疼痛分类系统（ECS-CP）的目标是创建一个用于癌症疼痛的国际分类系统。先前的研究强调需要标准化培训以确保评估者之间的一致性。目前还没有普遍接受的神经病理性疼痛分类方法。我们的主要目标是使用经过标准化培训的评估者，描述在不同样本的晚期癌症患者中 ECS-CP 特征的发生率。次要目标是：（1）使用神经病理性疼痛特殊兴趣小组（NeuPSIG）标准确定神经病理性疼痛的发生率；（2）检查以下特定预测因子与神经病理性疼痛之间的关系：ECS-CP 特征、年龄、姑息治疗表现量表、吗啡等效日剂量（MEDD）、环境和疼痛强度。从加拿大 11 个地点招募了 1050 名患有晚期癌症的成年患者。一名临床医生完成了 ECS-CP 和 NeuPSIG 标准，并收集了包括人口统计学和疼痛强度（现在）在内的其他信息。所有评估者都接受了标准化培训。在 1050 名可评估的患者中，有 910 名（87%）患有癌症疼痛：伤害感受性（=626；68.8%）；神经病理性（=227；24.9%）；新发（=329；36.2%）；心理困扰（=209；23%）；成瘾行为（=51；5.6%）；正常认知（=639；70.2%）。ECS-CP 特征和疼痛强度评分在不同地点和环境中有所不同，急性环境中的复杂疼痛特征发生率更高。神经病理性疼痛的总体频率为 24.9%，从环境中的 11%（临终关怀）到 34.2%（姑息治疗门诊）不等。多变量逻辑回归分析显示，年龄<60 岁、MEDD≥19mg、疼痛强度≥7/10、新发疼痛是神经病理性疼痛的独立显著预测因子（<0.05）。ECS-CP 能够在不同环境中检测到显著的疼痛特征。此外，使用 NeuPSIG 标准确定的神经病理性疼痛发生率与文献估计值（13%-40%）的较低端相吻合。需要进一步的研究来验证癌症疼痛的 NeuPSIG 标准。
