The Edmonton Classification System for Cancer Pain in Patients with Bone Metastasis: a descriptive cohort study.
Bone pain
Opioid
Pain control
Symptom assessment
Journal
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
ISSN: 1433-7339
Titre abrégé: Support Care Cancer
Pays: Germany
ID NLM: 9302957
Informations de publication
Date de publication:
28 Apr 2023
28 Apr 2023
Historique:
received:
23
08
2022
accepted:
27
03
2023
medline:
1
5
2023
pubmed:
28
4
2023
entrez:
27
4
2023
Statut:
epublish
Résumé
We describe the prevalence of the Edmonton Classification System for Cancer Pain (ECS-CP) features in patients with bone metastasis and cancer-induced bone pain (CIBP) and the relationship between ECS-CP features, pain intensity, and opioid consumption. We assessed ECS-CP features and recoded pain mechanisms and opioid use in adult patients with bone metastasis. Validated measures were used to assess pain intensity, incident pain, psychological distress, addictive behavior, and cognition. Among 147 eligible patients, 95.2% completed the assessment. Mean participant age was 73.2 years, the majority female (52.1%) with breast cancer occurring most commonly (25.7%). One or more ECS-CP features were present in 96.4% and CIBP in 75.7% of patients. The median average and worst pain scores were 3 and 6, respectively. Neuropathic pain was the most prevalent pain mechanism (45.0%) and was associated with breakthrough pain frequency (p=0.014). Three-quarters had incident pain, which was strongly associated with a higher average and worst pain scores (3.5 and 7, p<0.001 for both), background oral morphine equivalent daily dose (26.7mg, p=0.005), and frequency of daily breakthrough analgesia (1.7 doses/day, p=0.007). Psychological distress (n=90, 64.3%) was associated with a significantly higher average pain score (4, p=0.009) and a slightly higher worst pain score (7, p=0.054). Addictive behaviour and cognitive dysfunction were relatively uncommon (18.6% and 12.9%, respectively). There is a need to promote standardized assessment and classification of pain syndromes such as CIBP. The ECS-CP may allow us to consider CIBP in a systematic manner and develop personalized pain interventions appropriate to the pain profile. Retrospectively registered in ANZCTR ACTRN12622000853741 (16/06/2022).
Identifiants
pubmed: 37106261
doi: 10.1007/s00520-023-07711-9
pii: 10.1007/s00520-023-07711-9
pmc: PMC10140090
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
305Informations de copyright
© 2023. The Author(s).
Références
Macedo F, Ladeira K, Pinho F, Saraiva N, Bonito N, Pinto L, Goncalves F (2017) Bone Metastases: An Overview Oncol Rev 11(1):321. https://doi.org/10.4081/oncol.2017.321
doi: 10.4081/oncol.2017.321
pubmed: 28584570
Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12(20 Pt 2):6243s–6249s. https://doi.org/10.1158/1078-0432.CCR-06-0931
doi: 10.1158/1078-0432.CCR-06-0931
pubmed: 17062708
Zajaczkowska R, Kocot-Kepska M, Leppert W, Wordliczek J (2019) Bone pain in cancer patients: mechanisms and current treatment. Int J Mol Sci 20(23). https://doi.org/10.3390/ijms20236047
O’Sullivan GJ, Carty FL, Cronin CG (2015) Imaging of bone metastasis: an update. World J Radiol 7(8):202–211. https://doi.org/10.4329/wjr.v7.i8.202
doi: 10.4329/wjr.v7.i8.202
pubmed: 26339464
pmcid: 4553252
Ahmad I, Ahmed MM, Ahsraf MF, Naeem A, Tasleem A, Ahmed M, Farooqi MS (2018) Pain management in metastatic bone disease: a literature review. Cureus 10(9):e3286. https://doi.org/10.7759/cureus.3286
doi: 10.7759/cureus.3286
pubmed: 30443456
pmcid: 6235631
Laird BJ, Walley J, Murray GD, Clausen E, Colvin LA, Fallon MT (2011) Characterization of cancer-induced bone pain: an exploratory study. Support Care Cancer 19(9):1393–1401. https://doi.org/10.1007/s00520-010-0961-3
doi: 10.1007/s00520-010-0961-3
pubmed: 20680354
Falk S, Dickenson AH (2014) Pain and nociception: mechanisms of cancer-induced bone pain. J Clin Oncol 32(16):1647–1654. https://doi.org/10.1200/JCO.2013.51.7219
doi: 10.1200/JCO.2013.51.7219
pubmed: 24799469
Middlemiss T, Laird BJ, Fallon MT (2011) Mechanisms of cancer-induced bone pain. Clin Oncol (R Coll Radiol) 23(6):387–392. https://doi.org/10.1016/j.clon.2011.03.003
doi: 10.1016/j.clon.2011.03.003
pubmed: 21683564
Mantyh PW (2014) Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care 8(2):83–90. https://doi.org/10.1097/SPC.0000000000000048
doi: 10.1097/SPC.0000000000000048
pubmed: 24792411
pmcid: 4068714
Vieira C, Fragoso M, Pereira D, Medeiros R (2019) Pain prevalence and treatment in patients with metastatic bone disease. Oncol Lett 17(3):3362–3370. https://doi.org/10.3892/ol.2019.10013
doi: 10.3892/ol.2019.10013
pubmed: 30867771
pmcid: 6396205
Habberstad R, Hjermstad MJ, Brunelli C, Kaasa S, Bennett MI, Pardon K, Klepstad P (2019) Which factors can aid clinicians to identify a risk of pain during the following month in patients with bone metastases? A longitudinal analyses Support Care Cancer 27(4):1335–1343. https://doi.org/10.1007/s00520-018-4405-9
doi: 10.1007/s00520-018-4405-9
pubmed: 30105665
Canal-Sotelo J, Trujillano-Cabello J, Larkin P, Arraras-Torrelles N, Gonzalez-Rubio R, Rocaspana-Garcia M, Barallat-Gimeno E (2018) Prevalence and characteristics of breakthrough cancer pain in an outpatient clinic in a Catalan teaching hospital: incorporation of the Edmonton Classification System for Cancer pain into the diagnostic algorithm. BMC Palliat Care 17(1):81. https://doi.org/10.1186/s12904-018-0336-y
doi: 10.1186/s12904-018-0336-y
pubmed: 29807537
pmcid: 5971419
Caraceni A, Shkodra M (2019) Cancer pain assessment and classification. Cancers (Basel) 11(4). https://doi.org/10.3390/cancers11040510
Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M, Galloway L, Kaye G, Landman W, Spruyt O, Zhukovsky D, Bruera E, Hanson J (2010) An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 46(16):2896–2904. https://doi.org/10.1016/j.ejca.2010.04.017
doi: 10.1016/j.ejca.2010.04.017
pubmed: 20483589
Nekolaichuk CL, Fainsinger RL, Lawlor PG (2005) A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for Cancer Pain. Palliat Med 19(6):466–476. https://doi.org/10.1191/0269216305pm1055oa
doi: 10.1191/0269216305pm1055oa
pubmed: 16218159
Nekolaichuk C, Fainsinger RL, Lawlor P, Hagen N, Berkovitch M. Fisch M, Galloway L, Kaye G, Landman W, Spruyt O, Zhukovsky D, Bruera E, Hanson J. (2010) A predictive model for identifying complex cancer pain syndromes in patients referred to specialist palliative care services using a pain classification system [abstract]. Palliat Med 24(4, Suppl):S42
Arthur J, Tanco K, Haider A, Maligi C, Park M, Liu D, Bruera E (2017) Assessing the prognostic features of a pain classification system in advanced cancer patients. Support Care Cancer 25(9):2863–2869. https://doi.org/10.1007/s00520-017-3702-z
doi: 10.1007/s00520-017-3702-z
pubmed: 28386785
Lawlor PG, Lawlor NA, Reis-Pina P (2018) The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. Expert Rev Qual Life in Cancer Care 3(2-3):47–64. https://doi.org/10.1080/23809000.2018.1467211
doi: 10.1080/23809000.2018.1467211
Webber K, Davies AN, Zeppetella G, Cowie MR (2014) Development and validation of the breakthrough pain assessment tool (BAT) in cancer patients. J Pain Symptom Manag 48(4):619–631. https://doi.org/10.1016/j.jpainsymman.2013.10.026
doi: 10.1016/j.jpainsymman.2013.10.026
Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G, Science Committee of the Association for Palliative Medicine of Great B, Ireland (2009) The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 13(4):331–338. https://doi.org/10.1016/j.ejpain.2008.06.014
doi: 10.1016/j.ejpain.2008.06.014
pubmed: 18707904
Ownby KK (2019) Use of the distress thermometer in clinical practice. J Adv Pract Oncol 10(2):175–179
pubmed: 31538028
pmcid: 6750919
Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2014) Validation of the distress thermometer worldwide: state of the science. Psychooncology 23(3):241–250. https://doi.org/10.1002/pon.3430
doi: 10.1002/pon.3430
pubmed: 25160838
Hinkin CH, Castellon SA, Dickson-Fuhrman E, Daum G, Jaffe J, Jarvik L (2001) Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. Am J Addict 10(4):319–326
doi: 10.1111/j.1521-0391.2001.tb00521.x
pubmed: 11783746
Wade DT, Vergis E (1999) The Short Orientation-Memory-Concentration Test: a study of its reliability and validity. Clin Rehabil 13(2):164–170. https://doi.org/10.1191/026921599673848768
doi: 10.1191/026921599673848768
pubmed: 10348397
Bruera E, Schoeller T, Wenk R, MacEachern T, Marcelino S, Hanson J, Suarez-Almazor M (1995) A prospective multicenter assessment of the Edmonton staging system for cancer pain. J Pain Symptom Manag 10(5):348–355. https://doi.org/10.1016/0885-3924(95)00052-z
doi: 10.1016/0885-3924(95)00052-z
Arthur J, Yennurajalingam S, Nguyen L, Tanco K, Chisholm G, Hui D, Bruera E (2015) The routine use of the Edmonton Classification System for Cancer Pain in an outpatient supportive care center. Palliat Support Care 13(5):1185–1192. https://doi.org/10.1017/S1478951514001205
doi: 10.1017/S1478951514001205
pubmed: 25311930
Atisook R, Euasobhon P, Saengsanon A, Jensen MP (2021) Validity and utility of four pain intensity measures for use in international research. J Pain Res 14:1129–1139. https://doi.org/10.2147/JPR.S303305
doi: 10.2147/JPR.S303305
pubmed: 33907460
pmcid: 8071079
Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A et al (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. The Lancet Oncol 13(2):e58–e68. https://doi.org/10.1016/S1470-2045(12)70040-2
doi: 10.1016/S1470-2045(12)70040-2
pubmed: 22300860
Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M (2013) Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev Cent East Eur 16(2):66–69. https://doi.org/10.5603/NMR.2013.0037
doi: 10.5603/NMR.2013.0037
pubmed: 24068635
van der Velden JM, van der Linden YM, Versteeg AL, Verlaan JJ, Sophie Gerlich A, Pielkenrood BJ, Kasperts N, Verkooijen HM (2018) Evaluation of effectiveness of palliative radiotherapy for bone metastases: a prospective cohort study. J Radiat Oncol 7(4):325–333. https://doi.org/10.1007/s13566-018-0363-6
doi: 10.1007/s13566-018-0363-6
pubmed: 30595809
pmcid: 6290653
Zhen G, Fu Y, Zhang C, Ford NC, Wu X, Wu Q, Yan D, Chen X, Cao X, Guan Y (2022) Mechanisms of bone pain: progress in research from bench to bedside. Bone Res 10(1):44. https://doi.org/10.1038/s41413-022-00217-w
doi: 10.1038/s41413-022-00217-w
pubmed: 35668080
pmcid: 9170780
Park SH, Eber MR, Widner DB, Shiozawa Y (2018) Role of the bone microenvironment in the development of painful complications of skeletal metastases. Cancers (Basel) 10(5):141. https://doi.org/10.3390/cancers10050141
doi: 10.3390/cancers10050141
pubmed: 29747461
Fallon M, Hoskin PJ, Colvin LA, Fleetwood-Walker SM, Adamson D, Byrne A, Murray GD, Laird BJ (2016) Randomized double-blind trial of pregabalin versus placebo in conjunction with palliative radiotherapy for cancer-induced bone pain. J Clin Oncol 34(6):550–556. https://doi.org/10.1200/JCO.2015.63.8221
doi: 10.1200/JCO.2015.63.8221
pubmed: 26644535
Bennett MI (2010) Cancer pain terminology: time to develop a taxonomy that promotes good clinical practice and allows research to progress. Pain 149(3):426–427. https://doi.org/10.1016/j.pain.2010.01.013
doi: 10.1016/j.pain.2010.01.013
pubmed: 20189304
Bennett MI, Kaasa S, Barke A, Korwisi B, Rief W, Treede RD, Pain ITftCoC (2019) The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain 160(1):38–44. https://doi.org/10.1097/j.pain.0000000000001363
doi: 10.1097/j.pain.0000000000001363
pubmed: 30586069
Nekolaichuk CL, Fainsinger RL, Aass N, Hjermstad MJ, Knudsen AK, Klepstad P, Currow DC, Kaasa S, European Palliative Care Research C (2013) The Edmonton Classification System for Cancer Pain: comparison of pain classification features and pain intensity across diverse palliative care settings in eight countries. J Palliat Med 16(5):516–523. https://doi.org/10.1089/jpm.2012.0390
doi: 10.1089/jpm.2012.0390
pubmed: 23614710
Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, Slama O, Korhonen T, Filbet M, Poulain P, Mystakidou K, Ardavanis A, O’Brien T, Wilkinson P, Caraceni A, Zucco F, Zuurmond W, Andersen S, Damkier A et al (2013) Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manag 46(5):619–628. https://doi.org/10.1016/j.jpainsymman.2012.12.009
doi: 10.1016/j.jpainsymman.2012.12.009
Davis MP (2018) Cancer-related neuropathic pain: review and selective topics. Hematol Oncol Clin North Am 32(3):417–431. https://doi.org/10.1016/j.hoc.2018.01.005
doi: 10.1016/j.hoc.2018.01.005
pubmed: 29729778
Lee DY, Lee JJ, Richeimer SH (2021) Cancer pain syndromes. Cancer Treat Res 182:17–25. https://doi.org/10.1007/978-3-030-81526-4_2
doi: 10.1007/978-3-030-81526-4_2
pubmed: 34542873
Fallon MT (2013) Neuropathic pain in cancer. Br J Anaesth 111 (1):105-111. https://doi.org/10.1093/bja/aet208
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpaa M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14(2):162–173. https://doi.org/10.1016/S1474-4422(14)70251-0
doi: 10.1016/S1474-4422(14)70251-0
pubmed: 25575710
pmcid: 4493167
Ulas S, Eyigor S, Caramat I (2018) Quality of life and neuropathic pain in hospitalized cancer patients: a comparative analysis of patients in palliative care wards versus those in general wards. Indian J Palliat Care 24(3):325–333. https://doi.org/10.4103/IJPC.IJPC_12_18
doi: 10.4103/IJPC.IJPC_12_18
pubmed: 30111947
pmcid: 6069618
Brzakala J, Leppert W (2019) The role of rapid onset fentanyl products in the management of breakthrough pain in cancer patients. Pharmacol Rep 71(3):438–442. https://doi.org/10.1016/j.pharep.2019.01.010
doi: 10.1016/j.pharep.2019.01.010
pubmed: 31003154
Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92(1-2):147–157. https://doi.org/10.1016/s0304-3959(00)00482-6
doi: 10.1016/s0304-3959(00)00482-6
pubmed: 11323136
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lanteri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114(1-2):29–36. https://doi.org/10.1016/j.pain.2004.12.010
doi: 10.1016/j.pain.2004.12.010
pubmed: 15733628
Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DLH, Bouhassira D, Cruccu G, Freeman R, Hansson P, Nurmikko T, Raja SN, Rice ASC, Serra J, Smith BH, Treede RD, Jensen TS (2016) Neuropathic pain: an updated grading system for research and clinical practice. Pain 157(8):1599–1606. https://doi.org/10.1097/j.pain.0000000000000492.PMID:27115670;PMCID:PMC4949003
doi: 10.1097/j.pain.0000000000000492.PMID:27115670;PMCID:PMC4949003
pubmed: 27115670
pmcid: 4949003