**4.3 Edmonton classification system for cancer pain (ECS-CP)**

To improve on the IASP system of classification for chronic pain, there is a better versed and more widely accepted method of classification called ECS-CP (Edmonton Classification System for Cancer Pain) also is incorporated in the multisite of European Palliative Care Research Collaborative (EPCRC) [3, 4]. It is a more rigorous and user-friendly system of pain classification compared to the previous iterations for classifying pain. Additional descriptive features for pain classification are also incorporated such as the patient's emotional wellbeing. Other than this it incorporates seven components to evaluate the patient as suggested by Bruera E.[4]:

Domain 1-Mechanism of pain Domain 2- Characteristics Domain 3- Cognitive function Domain 4- Previous opioid use Domain 5-Psychological distress Domain 6- Tolerance Domain 7-History of such related pain [2, 4, 37].

Hence it is implied that this is better for further prognosis and pain treatment as this not only keeps check on the emotional/psychological distress but also considers the patient history of having difficulties in the same area or maybe similar types of pain [2, 4, 37]. Also, to be noted that it also checks whether if there is any case of taking opioids and if due to pain there is any cognitive impairment in the concerned patient though their involvement is still debated in the process of pain assessment in the newer version of this model. This method of assessment and prognosis of pain has widely been reviewed and validated in many studies and there is still improvement going on.

ECS-CP questionnaire categories are further dived into subcategories such as the understanding mechanism of pain it can be divided into the following subcategories (**Table 1**) [4]. These can be denoted by a letter such as N for the


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fields [34].

*4.4.1 Why pain arises?*

*Assessment and Management of Pain in Palliative Care DOI: http://dx.doi.org/10.5772/intechopen.96676*

**4.4 Alberta breakthrough pain assessment tool (ABPAT)**

their function [2, 4].

category and subcategory can be in small caps alphabetic or numerical, the lower sub-feature as seen provides more information higher the chances of good prognosis. Similarly, for the rest of the groups depending on the new version such as opioid intake, tolerance, they are also divided into subcategories according to

ABPAT was developed by Alberta Cancer Board and the Alberta Cancer Foundation. It is an emerging tool for pain prognostics and works under the boundaries of assessing breakthrough pain. This method was developed by a knowledgeable panel of the reviewer by utilizing the Delphi process and conducting many patient's think-aloud interviews [34, 36]. Breakthrough pain is generally categorized as a sudden increase or flaring of existing chronic pain such as in cases of cancer or joint-related problems [33]. It is reported that breakthrough pain in cancer patients, its occurrence is about 40–93%, hence quite common as it has come up quite a lot of times that no standardized assessment tool exists so the goal of Alberta breakthrough pain assessment tool was to provide a standardized format for research purposes [34]. Using the opinion of experts in this field reaching a consensus a questionnaire of 17 questions was put out. Next came the validation of this process, whether the patients were understanding what they have been asked to fill up so that the researcher added the think-aloud to judge the comprehensive and cognitive understanding of the people participating in the survey (**Figure 4**). This helped in the revaluation of their question by rigorous

feedback from the participants and adding any changes in between.

This was well evaluated in a study conducted that was mentioned by Sperlinga

R. where approximately 90% of the participants said that the questions were understandable and 80% said that it is a good tool for the breakthrough problem [35]. The validation and reviewing of the results were done both nationally and internationally such as in UK, Australia, Middle-East, Israel and North America and many respondents that participated in the survey were from medical nursing

Pain is the 3rd most common symptom of cancer and reportedly has many reasons for the cause of pain from cancer [38]. It winds up being the patient-related factors such as, the location of the tumor, the neural system and the tissue being affected, stage of cancer its malignancy etc. People also suffer from pain related discomfort while going through the treatment of cancer which includes surgery for the removal of the tumor from the affected area, chemotherapy and radiotherapy

The format of questions participants was asked:

• Relationship to the baseline pain

• Quality, duration and frequency of pain

• Location and intensity of pain

• Response to medication [34].

• Predictability of pain

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

**176**

**S.No**

**Mechanism Of** 

**Your** 

**Characteristics** 

**Your** 

**Cognitive** 

**Your** 

**Psychological** 

**Your** 

**Past History** 

**Your** 

**Of Addictive** 

**Response**

**Abuse (A)**

Yes, Present

**Response**

**Distress (P)**

**Response**

**Function (F)**

**Response**

**Response**

**Of Pain (C)**

**Pain (M)**

1 2 3

No Pain Felt

Neuropathic Pain

Non- Incident

Pains

No Incident

Pains

Specify if, Psychological distress is present: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Specify if, Past history of addictive abuse: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*Result: M\_\_C\_\_F\_\_P\_\_A\_\_*

**Table 1.**

*ECS-CP questionnaire.*

Nociceptive Pain

Incident Pains

Normal

No Distress

Functioning

Abnormal

Distress

Not Present

Present

Functioning

category and subcategory can be in small caps alphabetic or numerical, the lower sub-feature as seen provides more information higher the chances of good prognosis. Similarly, for the rest of the groups depending on the new version such as opioid intake, tolerance, they are also divided into subcategories according to their function [2, 4].
