Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer

PAIN Reports, vol. 9, pp. e1140

Abstract

Abstract Introduction: Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy. Objectives: Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST). Methods: This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0–10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal–Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP. Results: Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2–94.3) and 98.3% (95% CI 90.8–100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia (P = 0.0032), warm hypoesthesia (P = 0.0018), pressure hyperalgesia (P = 0.02), and the presence of allodynia (P = 0.0001). Conclusion: The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.

Authors 12

1. Morena Shkodra corresponding

   University of Oslo · Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Institute of Clinical Medicine, University of Oslo, Oslo, Norway

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

2. Matthew R Mulvey

   University of Leeds

   Affiliation as printed

   Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom

3. Marie Fallon

   University of Edinburgh

   Affiliation as printed

   Department of Palliative Medicine, University of Edinburgh, Edinburgh, United Kingdom

4. Cinzia Brunelli

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

5. Ernesto Zecca

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

6. Paola Bracchi

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

7. Mariangela Caputo

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

8. Giacomo Massa

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

9. Silvia Lo Dico

   Fondazione IRCCS Istituto Nazionale dei Tumori

   Affiliation as printed

   Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

10. Roman Rolke Aachen Department of Palliative Medicine Medical Faculty

    RWTH Aachen University

    Affiliation as printed

    Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany

11. Stein Kaasa

    Oslo University Hospital · University of Oslo

    Affiliation as printed

    Department of Oncology, Oslo University Hospital, Oslo, Norway

    Institute of Clinical Medicine, University of Oslo, Oslo, Norway

12. Augusto Tommaso Caraceni

    University of Milan · Fondazione IRCCS Istituto Nazionale dei Tumori

    Affiliation as printed

    Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy