Classification of pain in cancer patients--a systematic literature review
| Autor: | A. Caraceni, Nina Aass, Marit S. Jordhøy, Pål Klepstad, Stein Kaasa, M. J. Hjermstad, Robin L. Fainsinger, Anne Kari Knudsen |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Pain Neoplasms medicine Humans Pain Management Depression (differential diagnoses) Pain Measurement Evidence-Based Medicine business.industry Palliative Care Cancer General Medicine medicine.disease Substance abuse Anesthesiology and Pain Medicine Systematic review Opioid Existing Treatment Practice Guidelines as Topic Physical therapy Female Cancer pain business medicine.drug |
| Zdroj: | Palliative medicine. 23(4) |
| ISSN: | 1477-030X |
| Popis: | Cancer pain classification – what should be the content of a future system? Pain is a subjective, complex and burdensome symptom which is very common in cancer patients. Despite existing treatment guidelines, several cancer patients still do not receive optimal pain treatment, in particular patients with advanced disease. The lack of a common classification system for cancer pain – a diagnostic tool – has been identified as one of several causes for this undertreatment. Motivated by these considerations, the international EU-funded ‘European Palliative Care Research Collaborative’ (EPCRC) was established. One of the main aims was to develop a classification system for three common symptoms in cancer patients with advanced disease: pain, depression, and cancer related weight loss. The papers included in this thesis have been performed in close collaboration with the EPCRC. The overall aim of the thesis is to contribute in the development process of an international classification system for pain in cancer patients by for example to identify factors that are important for describing pain and thus improve diagnostics and treatment of cancer pain. The main results in this thesis are: There are several systems for pain classification in cancer patients, but none of these are widely used in research or in clinical practice. Pain intensity and pathophysiology, the presence of breakthrough pain, psychological distress, and response to treatment are included in two or more of the six formal systems that were identified by systematically reviewing existing literature. Patients confirmed in interviews that the factors identified to be important for cancer pain in previous studies, were relevant also for their experience of pain. They emphasised physical and psychological aspects of being in pain, and sleep was considered important. In an European study where more than 2000 cancer patients using strong pain medication (opioids) participated, the following factors were identified to be of importance for the degree of pain intensity and pain relief: breakthrough pain, localisation of pain, opioid dose, use of weak pain medication, sleep, psychological distress, pathophysiology of pain, substance abuse, cancer diagnosis, and localisation of metastases. In an Italian study where 1800 cancer patients participated, the relevance of the five first factors listed above was confirmed. Furthermore, results from the same study showed that pain intensity and pain relief measured at study start as well as the presence of breakthrough pain, localisation of pain, age, and cancer diagnosis were factors that could predict pain after two weeks. At least three major challenges for the further development a future international classification system for cancer pain: to choose the most relevant factors (and how many) to include in the system, to achieve agreement on what outcomes to use, and finally to start using the classification system in clinical practice |
| Databáze: | OpenAIRE |
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