**4.2 Cancer pain prognostics scale**

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

**4. Methods of pain assessment (pain assessment tools)**

the lymph [6]. Similarly, widely used pain assessment tools are

• Edmonton classification system for cancer pain -ECS-CP

• Alberta breakthrough pain assessment tool [33–36].

chronic pain taxonomy

**Chronic Pain Taxonomy**

• Cancer pain prognostic scale-CPPS [3].

and episodic pain (pain that comes and goes) [2].

Domain 1-The site where the pain occurs

Domain 5-Pain etiology [3].

Domain 2-Organ systems that get affected due to pain

Assessment is the rigorous process of documentation, self-knowledge and interpretation. The need for cancer pain assessment during and after the treatment at the end-of-life stage is very important. Many contributing factors may affect the diagnosis of the source of the pain. Due to the varied nature complexity in the classification of pain, there is no consensus on a common pain assessment tool. This is to be noted and a common effective method should be there to evaluate the pain and its history in the patient. Since the pain assessed is in the boundary of cancer, the method to stage malignancy and its type is measured by TNM classification of cancer. Since its discovery, it has been proficiently helping in the further planning of treatment to be provided. With the staging ranging from 1 to 4 with the fourth being severe [3, 6]. TNM staging plays an important role in the assessment of the pain as it can convey information about size, if it is malignant or if it has spread into

• International Association for the Study of Pain -IASP assessment tool for

**4.1 International Association for the Study of Pain (IASP)- Assessment Tool for** 

It is a symptom sign-based type of deducing the effects of chronic pain in the patient. It is the list of diseases that provide information and classification of pain. Studies on the basis of the location of occurrence the pain, where it is present in the body. Next comes how the patient feels the pain like it is pinching, radiating or may be flickering in nature or does it change as time passes. This helps the clinical person to deduce the type of pain whether neuropathic or nociceptive and also possible organ system that is affected by the pain by deducing if it is visceral or somatic. The last consideration taken is the intensity of the pain [3, 14]. To extract this information, the patient is asked to fill up a questionnaire such as the McGill pain questionnaire which deals with [7, 14]. The problem with such classification of pain is that it is not predictive in similar aspects to TNM which is predictive and can give an idea on how to plan the treatment [3, 6]. Due to much-received criticism, changes were done in 2011 namely, the International Classification of Disease 11th revision (ICD -11) was for chronic pain groups such as chronic cancer pain involving the use of visceral and neuropathic pain and also adding continuous pain

The IASP classification of chronic pain is done by using these following

Domain 3-Temporal characteristics deal with the frequency of pain Domain 4-Intensity of the pain and time passed since its onset

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groups/ domains

It is a numerical-based scale for characterizing and for running prognostic assessment of the condition and it is more predictive as compared to the previous ones. It is based on the scores ranging from 0 to 17, where the higher the scoring on this scale the good/better the prognosis and better chances of pain relief. Hence, this is a very useful tool in determining poor prognostics amongst patients [2]. This scaling has added features compared to IASP assessment for pain such as

Domain 1-Worst of pain Domain 2- Emotional well-being of the patient Domain 3- Pain characteristics Domain 4- Daily opioid consumption [3].

Where scaling for worst pain is given from 1 to10, for emotional well-being is judged by using Functional Assessment of Cancer Therapy (FACT-G) and the daily opioid dose is monitored for greater than 60 mg consumption as its higher levels of it will make it difficult to control pain and person seems to be more tolerant [3].
