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Symptoms Assessment Tools - Pain

The Edmonton Classification System for Cancer Pain (ECS-CP)

Summary

The Edmonton Classification System for Cancer Pain is a validated assessment instrument for pain classification in cancer patients. It consists of five pain features: mechanism of pain, incident pain, psychological distress, addictive behavior, and cognitive function. It is a clinician-rated assessment, based on an integration of clinical findings including but not limited to the patient history, patient reports, physical examination, medical record, objective assessments, available diagnostic imaging and collateral history. The ECS-CP helps to predict which cancer pain patients will be more difficult or time consuming to manage enables physicians and the inter-disciplinary team to better manage patients’ cancer pain, and better allocate resources. It also provides useful information for training palliative medicine and pain specialists in the assessment of pain staging/classification in cancer patients.

Tools

References

Fainsinger, R., Nekolaichuk, C., Lawlor, P., Hagen, N., Bercovitch, M., Fisch, M., Galloway, L., Kaye, G., Landman, W., Spruyt, O., Zhukovsky, D., Bruera, E., Hanson, J. (2010). An international multicentre validation study of a pain classification system for cancer patients. European Journal of Cancer, 46, 2896-- 2904.

Nekolaichuk CL, Fainsinger RL, Aass N, et al. (2013). The Edmonton Classification System for Cancer Pain: Comparison of pain classification features and pain intensity across diverse palliative care settings in eight countries. J of Palliative Medicine; 16(5):516-523.

Nekolaichuk CL, Fainsinger RL, Lawlor P. (2013). Challenges of conducting research on cancer pain classification: How do we make sense of the outcomes? J of Palliative Medicine; 16(11): 1323-1325.

Pain Assessment in Advanced Dementia Scale (PAINAD)

Summary

This pain behavior tool is used to assess pain in older adults who have dementia or other cognitive impairment and are unable to reliably communicate their pain. It can be used by a nurse or assistant to screen for pain related behaviors.

Tool

References

Leong, I., Chong, M., & Gibson, S. (2006). The use of self-reported pain measure, a nurse-reported pain measure, and the PAINAD in nursing home residents with moderate and severe dementia: a validation study. Age and aging, 35, 252-256.

Warden, V., Hurley, a., Volicer, L. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. American Medical Directors Association, 4, 9-15..

Checklist for Non-verbal Pain Indicators (CNPI)

Summary

The Checklist of Nonverbal Pain Indicators (CNPI) was designed to observe and measure pain behaviors in cognitively impaired elders. The tool includes six pain behavioral items commonly observed in older adults including nonverbal vocalizations, facial grimacing or wincing, bracing, rubbing, restlessness, vocal complaints.

Tool

References

Nygaard, H. A., & Jarland, M. (2006). The checklist of nonverbal pain indicators (CNPI): Testing of reliability and validity in Norwegian nursing homes. Age and Ageing, 35(1), 79-81.Morphine Equivalent Daily Dose (MEDD)

Summary

The Morphine Equivalent Daily Dose (MEDD) is used to translate the dose and route of each of the opioids the patient has received over the last 24 hours to a parenteral morphine equivalent using a standard conversion table.

Guideline

References

Bruera E, Lawlor P, Watanabe S, Turner K, Hanson J. (1997). The effects of opioid rotation (OR), dose ratio (DR) on pain control and cognition in patients (P) with cancer pain. Presented at the A.S.C.O. meeting in Denver, CO May 20, 1997. Proceedings of ASCO.; 16(212):62a

Charrois T, Lindsay MA, Bruera E. (1998). Utilizing a morphine equivalent daily dose for comparison of opioid use in two palliative care units in Canada. Presented at the 12th International Congress on Care of the Terminally Ill, Montreal, PQ September 1317, J Palliat Care; 14(3):117

The Brief Pain Inventory (BPI)

Copyright is held by Dr. Charles S. Cleeland (1991)

Summary

The Brief Pain Inventory is a medical questionnaire used to measure pain, developed by the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care. The purpose of the BPI is to assess the severity of pain and the impact of pain on daily functions. Originally developed to assess cancer pain, the BPI has been validated for use in the chronic nonmalignant pain population. It provides an important and widely used diagnostic tool for the clinician treating chronic pain.

Tool

Guidelines

References

Cleeland CS, Ryan KM. (1994). Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(2): 129-138.

Kalyadina SA, Ionova TI, Ivanova MO, Uspenskaya OS, Kishtovich AV, Mendoza TR, Guo H, Novik A, Cleeland CS, Wang XS. (2008). Russian Brief Pain Inventory: validation and application in cancer pain. J Pain Symptom Manage 35(1): 95-102.​​​​