Tolerance is difficult to include at initial assessment, given that the calculation requires time to implement. A validation study tolerance can be used as an outcome measure, using the initial and final (defined as the date of stable pain control/death) opioid dose, an opioid escalation index (OEI) can be calculated:



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Adapted from Fainsinger R el at. Edmonton Classification System for Cancer Pain (ECS-CP). Administration manual. AHS Edmonton Zone Palliative Care Program, CH Palliative Institute & University of Alberta. June 2019. Internet. Available at https://www.albertahealthservices.ca/assets/info/peolc/if-peolc-ed-ecs-cp-admin-manual.pdf. Accessed on November 6, 2020.