AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions

Abstract

Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy initiative worked to develop the characteristics of an optimal diagnostic system. After the establishment of these characteristics, a working group consisting of clinicians and clinical and basic scientists with expertise in cancer and cancer-related pain was convened to generate core diagnostic criteria for an illustrative sample of 3 chronic pain syndromes associated with cancer (ie, bone pain and pancreatic cancer pain as models of pain related to a tumor) or its treatment (ie, chemotherapy-induced peripheral neuropathy). A systematic review and synthesis was conducted to provide evidence for the dimensions that comprise this cancer pain taxonomy. Future efforts will subject these diagnostic categories and criteria to systematic empirical evaluation of their feasibility, reliability, and validity and extension to other cancer-related pain syndromes.

The use of quantitative sensory testing in cancer pain assessment: A systematic review

“…These spontaneous pain flares are usually located in areas where there is observed sensory dysfunction (hypersensitivity and/or hyposensitivity) (Baron et al, 2017;Fallon, 2013; Type of stimulus Haanpaa, 2013). Patients with NCP also experience other sensations such as dysesthesia, allodynia and hyperalgesia (Fallon, 2013;Haanpaa, 2013;Paice et al, 2017). Pain assessment and diagnostic guidelines propose the use of objective measurable tests such as quantitative sensory testing (QST , Table 1) to support the diagnosis of neuropathic pain (Cruccu et al, 2010;Cruccu & Truini, 2009;Finnerup et al, 2016;Haanpaa et al, 2011;Piano et al, 2012Piano et al, , 2013.…”

Breaking barriers to novel analgesic drug development

“…Attempts are being made to deal with bias and unreliability, most notably by ACTTION 16 , the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks a public-private partnership with the United States Food and Drug Administration (FDA). Trial design can be improved by better diagnostics, blinding and choice of primary outcome measure, adaptive designs, crossovers, and random withdrawal, use of adequate power and responder analyses 275 . However, there remains the problem that lack of predictive biomarkers either of pain or of target engagement makes it difficult to understand the underlying pathophysiology that leads to various clinical presentations of pain and if a drug is having any action, although new imaging technology may change this 276 .…”

The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

“…However, the name Cancer Pain Assessment and Classification System (CPACS) was proposed for this ideal classification tool. In the interim, further studies have been published in relation to the ECS-CP and its constituent domains [26][27][28][29][30][31][32][33][34][35]110], and three diagnostic models exemplifying chronic cancer associated pain syndromes have been proposed: bone pain, pancreatic cancer pain and chemotherapy-induced peripheral neuropathy [125]. There would appear to be some fragmentation of effort in developing a universally acceptable cancer pain classification system.…”