title: A "TNM" classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP).
abstract: OBJECTIVE
  The purpose of this paper is to provide an overview of the development of a "TNM" cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat.
  
  
  METHODS
  In response to this gap in clinical assessment, the Edmonton Staging System (ESS), a classification system for cancer pain, was developed. Difficulties in definitions and interpretation of some aspects of the ESS restricted acceptance and widespread use.
  
  
  RESULTS
  Construct, inter-rater reliability, and predictive validity evidence have contributed to the development of the ECS-CP. The five features of the ECS-CP--Pain Mechanism, Incident Pain, Psychological Distress, Addictive Behavior and Cognitive Function--have demonstrated value in predicting pain management complexity.
  
  
  CONCLUSIONS
  The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada. Robin.Fainsinger@capitalhealth.ca
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Nekolaichuk
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000145:classification* / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement / Q000592:standards*; D011237:Predictive Value of Tests; D012015:Reference Standards; D015203:Reproducibility of Results