The Edinburgh Pain Assessment and management Tool (EPAT) was created for the systematic assessment of cancer-related pain. Now, a study conducted in multiple cancer inpatient units describes how the EPAT could be routinely used to improve the pain-related outcomes of patients with cancer.

The use of the EPAT involves systematic recording of the worst pain (on a 0–10 scale) that patients have felt since last being assessed. Such measurements are incorporated into an algorithm that facilitates decision-making (including opioid prescription). This tool also involves regular reassessment of pain and opioid-related adverse events.

Of the current 40 cancer inpatient centres in the UK, 19 participated in this study. The primary outcome was change in the percentage of participants with a clinically significant improvement in pain, defined as a ≥2-point reduction in the severity of worst pain reported over the previous 24 h measured between admission and reassessment (3–5 days after admission). In the first phase of the study, cancer-related pain was managed following clinician’s judgement and according to local guidelines (defined as universal care; UC) between assessments. Centres were then randomly assigned to implement the EPAT (n = 10), or to keep providing UC (n = 9). Data from 50 patients per centre were used for the first phase of the study, and from 1,795 patients in the randomization phase. Patients had one of several cancer types, had a mean age of 60 years, and 49% were women.

The percentage of participants with a clinically significant improvement in worst pain increased from 47.7% in the initial phase to 54.1% after implementing the EPAT, but decreased from an initial 50.6% to 46.4% in centres that only provided UC. No difference existed in the percentage of patients who received ‘strong’ opioids (80%), or in the incidence of opioid-related adverse effects. In summary, EPAT is a tool that could be routinely used in to improve the management of pain in patients with cancer.