BackgroundSeveral guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy.ObjectivesTo determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC).MethodsConsecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model.ResultsOf 371 participants, 95 (25.6%) had PMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief ” scores were all less likely to be PMI(−).ConclusionThe potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.

Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics -by a registered medical practitioner for absolute pain control -is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.

One in three patients with cancer have an NPC, which is independently associated with recent chemotherapy, surgery, adjuvant analgesic use, episodic incident and breakthrough pain, longer pain duration, higher pain intensity, and pelvic or perineal pain location.

Introduction: Undertreatment of cancer pain is associated with inadequate assessment and inconsistent or non-standardized classification, resulting in failure to both appreciate its multidimensional nature and appropriately target therapeutic interventions. This review examines the classification of cancer pain with a focus on the progressive development of the Edmonton Classification System for Cancer Pain (ECS-CP); the appropriateness of its constituent features, associated outcomes and its potential future development in cancer pain classification. Areas covered: A Medline search from 1989 to November 2017, using combined terms 'cancer' or 'oncology', 'Edmonton', 'pain' or 'analgesia', and 'staging' or 'classification', identified 280 records. A total of 20 studies with empirical data relating to validation studies of the ECS-CP or evaluation of either its constituent or proposed domains were selected for inclusion in the core review. Expert commentary: The ECS-CP is a tool in evolution and a valid template for further cancer pain classification development. The assessment of ECS-CP domains requires a standardized approach. The domain ratings can inform the therapeutic strategy, and are associated with pain management outcomes, particularly stable pain control. The ECS-CP enables standardized reporting, based on patients' pain and related characteristics, and thus may improve the validity of comparisons across research study samples.

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