Pain Assessment and Management, 2nd Edition _ _________________________________________________
Performance is often impacted when a client experiences or fears cancer-related pain. The role of healthcare professionals is to assess the resulting effects on the client’s ability to participate in desired tasks and activities. Practitioners can then enable the individual to participate in those activities that improve their quality of life and help them to manage the pain. Primary intervention areas include pain, physical activity, fatigue, sleep, cognition, and psychosocial function (Newman et al., 2024). Self-Assessment Question 3. Which assessment is most effective when classifying cancer pain? A) The Canadian Occupational Performance Measure (COPM) B) The Edmonton Classification System for Cancer Pain (ECS-CP) C) The Owestry Assessment for Pain Management (OAPM) D) The Faces Pain Scale (FACES) COMPLEX REGIONAL PAIN SYNDROME CRPS is a rare and difficult disease. This condition is diag- nosed by exclusion, and a comprehensive workup is required to establish an accurate diagnosis. There are two distinct types, which are characterized by the presence or absence of neuronal injury. Type 1 indicates the presence of injury, and in Type 2, it is absent (Abd-Elsayed et al., 2024). Women over the age of 60 who have fallen and fractured the hand or wrist with constant pain and who were casted for about 4 weeks are at higher risk for developing CPRS (Diepold et al., 2023). The Budapest CRPS Diagnostic Criteria was updated and is considered the most reliable tool to assist with diagnosis (Gobel et al., 2021). The newer diagnostic criteria reflect sensory, vasomotor, sudomotor/edema, and motor/trophic clusters seen in CRPS. Table 3 shows the new IASP diagnostic criteria for CRPS (Budapest Criteria). CRPS can take a long time to diagnose, leading to impaired function, client distress, and dissatisfaction with the medical system. It is estimated that between 5 and 26 per 100,000 individuals are diagnosed with CPRS each year (Kessler et al., 2020). There are three types and three stages: type 1 (idio- pathic), type 2 (causalgia), and type 3 (nerve injury). When left untreated, CPRS moves through stages. Stage 1 is early acute and is characterized by pain/sensory abnormalities, vasomotor dysfunction, and prominent edema and sudomo- tor disturbances. Stage 2 is known as the dystrophic stage and has more pain and sensory dysfunction, continued vasomotor symptoms, and development of motor/trophic changes. Stage 3 is the atrophic or late stage. It has decreased pain/sensory disturbance, the vasomotor dysfunction continues, and the motor/trophic changes are significantly increased. It is known to spread. However, additional research is needed to deter- mine the cause (Kessler, 2020). Tests that can assist with the
SPECIFIC PAIN DIAGNOSES Many diagnoses that involve pain are familiar to most practi- tioners (e.g., back pain, arthritis, and carpal tunnel syndrome). However, some pain diagnoses are more rare or specific and therefore more difficult to diagnose and/or treat. The following diagnoses, which warrant additional explanation, are cancer pain, complex regional pain syndrome (CRPS), fibromyalgia, and pain across the lifespan. CANCER PAIN Pain is one of the most common symptoms reported by those diagnosed with cancer (Snijders et al., 2023). Currently, between 40% and 44.5% of all cancer patients report pain, and 30.6% report the level to be between moderate and severe (Evenepoel et al., 2022, Snijders et al., 2023). Pain related to cancer can be from the tumor itself or the therapies that are used to treat it, and it can often manifest in multiple areas. Frequently, the pain affects the individual’s ability to function and in turn their overall quality of life. Pergolotti et al. (2017) reported that African American race ( p < 0.05), comorbid conditions ( p < 0.02), and gastrointestinal cancers ( p < 0.05) are independently associated with a poor health-related qual- ity of life (HRQOL). There is a strong indication that there is a negative correlation between education, low income, and lower levels of wealth and pain (Youn et al., 2024). Unemploy- ment, uninsured status, or qualification for Medicaid were also found to be related to higher levels of pain. For 35.8% of clients diagnosed with cancer, the pain continues even after finishing a curative treatment (Snijders et al., 2023). There are times that clients with cancer are not heard when reporting pain. When measuring the cancer pain knowledge of health professionals, the mean knowledge score ranges between 36% and 95% (Galligan et al., 2024). These authors report that the most common gaps in knowledge are the pharmacology of analgesics in general, adverse effects, fear of tolerance or dependence on opioids, pain assessment, principles of cancer- related pain management, and use of nonpharmacological or interventional techniques. The Edmonton Classification System for Cancer Pain (ECS- CP) was developed by Bruera and Kim (2003) and adapted by Fainsinger et al. in 2005. It is considered one of the leading tools available to classify cancer pain; however, it is not being widely used (Caraceni & Shkodra, 2019). The ECS-CP takes into consideration the mechanism of pain, incident pain, psychological distress, addictive behavior, and cognitive func- tion (Fainsinger et al., 2019). Belayneh et al. (2023) report that 68.8% have nociceptive pain, 24.9% have neuropathic pain, 36.2% have incident pain, and 23% have psychological distress. These authors report that the more acute the setting, the higher the overall frequency. Age, morphine equivalent daily dose, pain intensity, and incident pain were significant predictors of neuropathic pain ( p < 0.05).
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