The use of Edmonton Classification System for Cancer Pain in Patients with Bone Metastasis: a cohort study

This study involves a single cross-sectional survey of cancer patients with bone metastasis to assess the five different components of the Edmonton Classification System for Cancer Pain (ECSCP):pain mechanism, incident pain, addictive behaviour, psychological distress and cognitive impairment. Each survey will take an average of 1-hour to complete. Pain mechanism was determined clinically by palliative care physician/specialist through a face-face or telehealth history and/or examination. Incident pain was documented using the Breakthrough pain assessment tool (BAT). Evidence of addictive behaviour was considered present if a patient score one or greater using the Cut down, Annoyed, Guilty and Eye-opener questionnaire adapted to include drugs (CAGE-AID). Cognitive function was assessed using the Short Orientation Memory Concentration Test (SOMCT) with score of 0-8: normal-minimum, 9-19: minimal to moderate and 20-28: severe cognitive impairment. Psychological distress was determined as present when scored four or greater using the Distress Thermometer (score range from 0-10). In addition to the ECS-CP features above, pain intensity scores were measured using the 11-point numeric rating scale with 0 representing no pain and 10 representing worse pain imaginable. Pharmacological pain management, including background opioid in oral morphine equivalent daily dose (OMEDD) and daily frequency of breakthrough opioid analgesia requirement were obtained from the participants directly or through the inpatient electronic Medication Management chart.