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Classification of pain in cancer patients – a systematic literature review

Pain and Palliation Research Group and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim University Hospital, Trondheim, anne.k.knudsen{at}ntnu.no

N Aass

Pain and Palliation Research Group and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim University Hospital, Trondheim; Division of Cancer Medicine and Radiotherapy, Rikshospitalet University Hospital, Oslo; The Cancer Center, Ullevål University Hospital, Oslo

R Fainsinger

Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta

A Caraceni

Palliative Care Unit, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milano

P Klepstad

Pain and Palliation Research Group and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim University Hospital, Trondheim; Department of Anaesthesiology and Emergency Medicine, Intensive Care Unit, St. Olav University Hospital, Trondheim

M Jordhøy

Cancer Unit, Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik

MJ Hjermstad

Pain and Palliation Research Group and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim University Hospital, Trondheim; The Cancer Center, Ullevål University Hospital, Oslo

S Kaasa

Pain and Palliation Research Group and Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim University Hospital, Trondheim; Palliative Medicine Unit, Department of Oncology, Trondheim University Hospital, Trondheim

One of the aims of the European Palliative Care Research Collaborative (EPCRC) is to achieve consensus on a classification system for cancer pain. We performed a systematic literature review to identify existing classification systems and domains/items used to classify cancer patients with pain. In a systematic search in the databases Medline and Embase, covering 1986–2006, 692 hits were obtained. 92 papers were evaluated to address pain classification. Six standardised classification systems were identified; three of them systematically developed and partially validated. Both pain characteristics and patient characteristics relevant for cancer pain classification were included in the classification systems. All but one of the standardised systems aim at predicting treatment response or adequacy of treatment. Several domains and items used to describe cancer pain but not formally described as part of a classification system were also identified and systematised. The existing approaches to pain classification in cancer patients are different, mostly not thoroughly validated, and none is widely applied. An internationally accepted classification system for cancer pain could improve research and cancer pain management. This systematic review suggests a need for developing an international consensus on how to classify pain in cancer patients.

Key Words: cancer • classification • pain • palliative care • symptoms • systematic review

This version was published on June 1, 2009

Palliative Medicine, Vol. 23, No. 4, 295-308 (2009)
DOI: 10.1177/0269216309103125


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