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Current Opinion in Supportive and... Jun 2020An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options. (Review)
Review
PURPOSE OF REVIEW
An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.
RECENT FINDINGS
The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.
SUMMARY
All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
Topics: Analgesics, Opioid; Breakthrough Pain; Cancer Pain; Fentanyl; Humans; Neoplasm Metastasis; Pain Management; Pain Measurement; Practice Guidelines as Topic; Severity of Illness Index; Transdermal Patch
PubMed: 32332210
DOI: 10.1097/SPC.0000000000000494 -
Current Pain and Headache Reports Jun 2014Breakthrough pain is a distinct pain state that is common in patients with cancer pain and which is associated with significant morbidity in this group of patients. The... (Meta-Analysis)
Meta-Analysis Review
Breakthrough pain is a distinct pain state that is common in patients with cancer pain and which is associated with significant morbidity in this group of patients. The aim of this article is to highlight important journal articles relating to breakthrough pain that have been published within the last year, including a systematic review of the epidemiology of breakthrough pain, the largest-ever study of the clinical features of breakthrough pain, and a network meta-analysis of the treatment of breakthrough pain.
Topics: Administration, Mucosal; Analgesics, Opioid; Breakthrough Pain; Female; Humans; Male; Morphine; Neoplasms; Pain Measurement
PubMed: 24760489
DOI: 10.1007/s11916-014-0420-9 -
Current Clinical Pharmacology May 2012Breakthrough pain (BTP) is a transitory exacerbation of pain that occurs on a background of otherwise controlled pain. It is associated in conjunction with severe... (Review)
Review
Breakthrough pain (BTP) is a transitory exacerbation of pain that occurs on a background of otherwise controlled pain. It is associated in conjunction with severe chronic pain and may result in impaired physical and psychological functioning, reduced effectiveness to opioids and also, increased financial burden. It manifests commonly in malignant pain, as manifested by well managed round the clock regular opioid medication but associated with intermittent sharp pain symptoms that are not controlled by the regular medication. It is a significant clinical problem and should be independently assessed and treated. The most common approach being used is 'rescue' medication--a short acting opioid in combination with the fixed-schedule opioid regimen. The lag time between peak pain intensity during an episode of BPT and onset of analgesia of most short-acting opioids is approximately 30-60 minutes. This suggests that the effectiveness of supplemental medications for BTP might be improved with analgesic agents that have a more rapid onset of action. Traditionally the rapid onset analgesia for breakthrough pain has been achieved by administering potent opioids through sublingual route bypassing the first pass metabolism. However with recent advances in drug delivery systems, transmucosal and buccal routes have gained popularity. Pharmacokinetic studies have demonstrated a high early systemic exposure to opioids well over their therapeutic dose range resulting in management of the breakthrough pain. This article proposes to review the evidence base on the effectiveness of these novel opioid delivery systems in managing the breakthrough pain.
Topics: Administration, Buccal; Administration, Sublingual; Analgesics, Opioid; Breakthrough Pain; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Delivery Systems; Humans; Time Factors
PubMed: 22432841
DOI: 10.2174/157488412800228893 -
Expert Review of Anticancer Therapy May 2018Breakthrough cancer pain (BTcP) is an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTcP... (Comparative Study)
Comparative Study Review
Breakthrough cancer pain (BTcP) is an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTcP is a heterogeneous condition as episodes vary between individuals. The aim of this article is to review the pharmacologic options for the management of BTcP. Areas covered: Recent reviews revealed that transmucosal preparations of fentanyl provided superior and more rapid pain relief as compared to placebo and oral morphine within the first 30 min after dosing. Few comparison studies among fentanyl products have been performed. Although dose titration has been recommended for years, a meaningful dosing, according to the level of opioid tolerance, may enhance the advantages of such products Expert commentary: BTcP represents a relevant problem reported by many cancer patients despite receiving regular use of opioids. Different modalities of pharmacological interventions are available. In comparison with oral opioids, fentanyl preparations appear to have a short onset and offset of analgesic effect, fitting the temporal characteristics of BTcP. Further studies are warranted to assess the net benefit of these drugs to assist decision-making by patients, clinicians, and payers, according to individual clinical conditions.
Topics: Administration, Buccal; Administration, Oral; Analgesics, Opioid; Breakthrough Pain; Cancer Pain; Dose-Response Relationship, Drug; Fentanyl; Humans; Morphine
PubMed: 29478355
DOI: 10.1080/14737140.2018.1443813 -
Seminars in Oncology Nursing Jun 2019To review the incidence of cancer pain; assessment of acute, chronic, and breakthrough pain; and provide insight on assessment approaches and reliable and valid... (Review)
Review
OBJECTIVES
To review the incidence of cancer pain; assessment of acute, chronic, and breakthrough pain; and provide insight on assessment approaches and reliable and valid instruments for clinical and research settings.
DATA SOURCES
Peer-reviewed journal articles, book chapters, Internet.
CONCLUSION
Quality pain management for patients with cancer is dependent on an accurate pain assessment and ongoing reassessment, considering the whole person. Being knowledgeable about evidence-based pain assessment practices is key.
IMPLICATIONS FOR NURSING PRACTICE
Concentrated efforts to address pain assessment barriers and effectively report pain assessments in diverse populations are warranted, especially in this current health care environment when pain assessment is challenging.
Topics: Cancer Pain; Humans; Neoplasms; Nursing Diagnosis; Pain Measurement; Substance-Related Disorders
PubMed: 31036386
DOI: 10.1016/j.soncn.2019.04.003 -
Expert Review of Anticancer Therapy Mar 2023Breakthrough pain (BP) is a complex phenomenon that has been reported to have a relevant role in the global management of cancer pain. Radiotherapy (RT) has a... (Review)
Review
INTRODUCTION
Breakthrough pain (BP) is a complex phenomenon that has been reported to have a relevant role in the global management of cancer pain. Radiotherapy (RT) has a fundamental part in the treatment of many pain conditions, particularly oral mucositis and painful bone metastases.
AREAS COVERED
The literature regarding the phenomenon of BP in the radiotherapy setting was reviewed. Three areas were assessed, including epidemiology, pharmacokinetics, and clinical data.
EXPERT OPINION
Qualitative and quantitative data regarding BP in the RT setting are poor in terms of scientific evidence. Most papers assessed fentanyl products, particularly fentanyl pectin nasal spray, to resolve possible problems with transmucosal absorption of fentanyl due to mucositis of the oral cavity in patients with head and neck cancer or to prevent and treat procedural pain during RT sessions. According to the lack of clinical studies with large number of patients, BP should be included in the agenda of radiation oncologists.
Topics: Humans; Breakthrough Pain; Analgesics, Opioid; Cancer Pain; Fentanyl; Head and Neck Neoplasms; Neoplasms
PubMed: 36809181
DOI: 10.1080/14737140.2023.2182773 -
Clinical Journal of Oncology Nursing Jun 2017Breakthrough cancer pain (BtCP), defined as a transient exacerbation of pain that occurs in conjunction with well-controlled background pain, is a common and burdensome... (Review)
Review
BACKGROUND
Breakthrough cancer pain (BtCP), defined as a transient exacerbation of pain that occurs in conjunction with well-controlled background pain, is a common and burdensome problem in patients with cancer. .
OBJECTIVES
The aim of this systematic review is to identify evidence-based pharmacologic modalities for adequate management of BtCP. .
METHODS
PubMed and CINAHL® databases were searched to identify literature regarding pharmacologic strategies for BtCP published from January 2006 to June 2016. These studies were then synthesized by the Oncology Nursing Society Putting Evidence Into Practice pain team. .
FINDINGS
Forty-four studies provide evidence for the use of opioids for the management of BtCP. Transmucosal immediate-release fentanyl (TIRF) was found to have the most evidence for BtCP. Five studies and guidelines also suggest that oral opioids (not including TIRF products) be dosed proportionally to baseline opioids at 10%-20% of the 24-hour, around-the-clock dose.
Topics: Administration, Oral; Analgesics, Opioid; Breakthrough Pain; Cancer Pain; Education, Nursing, Continuing; Fentanyl; Humans; Oncology Nursing; Pain Management
PubMed: 28524907
DOI: 10.1188/17.CJON.S3.71-80 -
Clinical Oncology (Royal College of... Aug 2011Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger, despite... (Review)
Review
Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. A typical episode of breakthrough pain has a fast onset and short duration, yet despite the self-limiting nature of each breakthrough pain, the repeated episodes can have a significant effect on patients' quality of life. Normal-release oral opioids have been the mainstay pharmacological approach for patients who are receiving an around the clock opioid regimen, but the onset and duration of action of oral opioids such as morphine may not be suitable for treating many breakthrough pains. Efforts to provide non-parenteral opioid formulations that could provide more rapid, and more effective, relief of breakthrough pain have led to the development of transmucosal opioid formulations.
Topics: Analgesics, Opioid; Humans; Neoplasms; Pain
PubMed: 21227666
DOI: 10.1016/j.clon.2010.12.002 -
Revista Espanola de Geriatria Y... 2017Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in... (Review)
Review
Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.
Topics: Aged; Algorithms; Cancer Pain; Disease Progression; Humans; Pain Management; Pain Measurement
PubMed: 27979661
DOI: 10.1016/j.regg.2016.10.003 -
Clinical & Translational Oncology :... Aug 2020In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It... (Review)
Review
In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.
Topics: Algorithms; Analgesics, Opioid; Breakthrough Pain; Cancer Pain; Communication; Fentanyl; Humans; Oncologists; Pain Management; Pain Measurement; Physician-Patient Relations; Practice Guidelines as Topic
PubMed: 32002739
DOI: 10.1007/s12094-019-02268-8