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Pain assessment tools in palliative care: an urgent need for consensus

Department of Oncology, Ullevaal University Hospital, Oslo; Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim m.j.hjermstad{at}medisin.uio.no

J Gibbins

Palliative Medicine Department, Bristol Haematology & Oncology Centre, University of Bristol, Bristol

DF Haugen

Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Haukeland

A Caraceni

Palliative Care (Pain Therapy – Rehabilitation) Fondazione IRCCS National Cancer Institute of Milan, Milan

JH Loge

National Resource Centre for Studies on Long-term Effects after Cancer, Rikshospitalet University Hospital, Rikshospitalet

S Kaasa

Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim

On behalf of the EPCRC, European Palliative Care Research Collaborative

At present, there is no universally accepted cancer pain assessment tool for use in palliative care (PC). The European Palliative Care Research Collaborative (EPCRC), therefore, aims to develop an international consensus-based computerised pain assessment tool. As part of this process, we have performed (1) a literature review on pain assessment tools for use in the PC and (2) an international expert survey to gain information on the relevant dimensions for pain assessment in PC. 230 publications were identified, only six met the inclusion criteria. Three further articles were identified through manual searching, totalling 11 different pain assessment tools. Nine tools were multidimensional. Pain intensity was assessed in seven, using various numerical/verbal rating scales (NRS/VRS); five tools focused on pain management. Three publications did not identify the rationale for the need to develop a new tool, and the selection procedure for items/dimensions was not described in six tools. Patient and/or professional expert groups were involved in the development of five tools and only two tools were extensively validated or cross-culturally tested. Thirty-two experts (71%) completed the expert survey and identified ‘intensity’, ‘temporal pattern’, ‘relief/exacerbation’, ‘pain quality’ and ‘location’ as the five most relevant dimensions. Most preferred assessment of ‘pain intensity’ was by NRS rather than VRS. Time windows extending 24 h were regarded as less relevant. Development of PC pain assessment tools seems to be a continuous process, which does not adhere to systematic guidelines, thus does not contribute to a universally accepted tool. No tool contained all relevant dimensions as defined by the experts. Many tools focused on particular dimensions, suggesting that specific research interests may drive the tool development process. Extensive literature reviews, expert and patient input and clinical studies are a needed approach in the development of a new consensus-based pain assessment tool.

Key Words: cancer • pain • pain assessment • palliative care

This version was published on December 1, 2008

Palliative Medicine, Vol. 22, No. 8, 895-903 (2008)
DOI: 10.1177/0269216308095701


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