title: An international multicentre validation study of a pain classification system for cancer patients.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Patients 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).
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  The replication of previous findings suggests that the ECS-CP can predict pain complexity in a range of practice settings and countries.
authors.affiliation: University of Alberta, Edmonton, Canada. Robin.Fainsinger@albertahealthservices.ca
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
authors.forename: Cheryl
authors.initials: C
authors.lastname: Nekolaichuk
authors.forename: Peter
authors.initials: P
authors.lastname: Lawlor
authors.forename: Neil
authors.initials: N
authors.lastname: Hagen
authors.forename: Michaela
authors.initials: M
authors.lastname: Bercovitch
authors.forename: Michael
authors.initials: M
authors.lastname: Fisch
authors.forename: Lyle
authors.initials: L
authors.lastname: Galloway
authors.forename: Gina
authors.initials: G
authors.lastname: Kaye
authors.forename: Willem
authors.initials: W
authors.lastname: Landman
authors.forename: Odette
authors.initials: O
authors.lastname: Spruyt
authors.forename: Donna
authors.initials: D
authors.lastname: Zhukovsky
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: John
authors.initials: J
authors.lastname: Hanson
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000145:classification* / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods*; D055815:Young Adult
chemical_list: D000700:Analgesics