An international multicentre validation study of a pain classification system for cancer patients |
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| Authors: | Robin L. Fainsinger Cheryl Nekolaichuk Peter Lawlor Neil Hagen Michaela Bercovitch Michael Fisch Lyle Galloway Gina Kaye Willem Landman Odette Spruyt Donna Zhukovsky Eduardo Bruera John Hanson |
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| Affiliation: | 1. University of Alberta, Edmonton, Canada;2. University of Ottawa, Ottawa, Canada;3. University of Calgary, Calgary, Canada;4. Tel Hashomer Hospice, Tel Aviv, Israel;5. M.D. Anderson Cancer Center, Houston, United States;6. South Auckland Hospice, Auckland, New Zealand;7. Middlemore Hospital, Auckland, New Zealand;8. Peter MacCallum Cancer Centre, Melbourne, Australia;9. Cross Cancer Institute, Edmonton, Canada;1. The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia;2. Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia;1. Royal Wolverhampton NHS Trust, Deanesly Centre, New Cross Hospital, Wolverhampton WV10 0QP, UK;2. Department of Radiography, Birmingham City University, B15 3TN, UK;1. Pain Research and Intervention Center of Excellence, Gainesville, Florida;2. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee;3. Department of Neurology in the Center for Human Experimental Therapeutics; and Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), University of Rochester School of Medicine and Dentistry, Rochester, New York;4. Department of Psychiatry and Behavioral Sciences, School of Medicine, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington;5. Department of Neurological Surgery, University of Washington, Seattle, Washington;1212. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington;7. Department of Psychiatry and Behavioral Neuroscience, and Director, Women''s Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio;11. Fibromyalgia Research Unit, Oregon Health & Science University, Portland, Oregon;12. Brigham & Women''s Hospital, Chestnut Hill, Massachusetts;8. Department of Neurology, Harvard Medical School, Cambridge, Massachusetts;9. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York;12121212. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland;71. Departments of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, California;112. Department of Pharmacology, University of Arizona, Tucson, Arizona;123. University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York;84. Clinical Epidemiology Unit, Boston, Massachusetts;95. Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York;121212121212. Director, Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois;77. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland;1111. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York;1212. Department of Oncology, Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins Hospital, Baltimore, Maryland;88. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington;99. Department of Medicine, University of Texas Medical Branch, Galveston, Texas;1212121212121212. Department of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania;1. Institute of Radiation Oncology, Sapienza University, Sant''Andrea Hospital, Rome, Italy;2. Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany |
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| Abstract: | PurposeThe 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.MethodsPatients 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).ResultsA 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.ConclusionThe replication of previous findings suggests that the ECS-CP can predict pain complexity in a range of practice settings and countries. |
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