Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

Mercadante, Sebastiano; Valle, Alessandro; Porzio, Giampiero; Aielli, Federica; Adile, Claudio; Ficorella, Corrado; Raineri, Santi Maurizio; Giarratano, A; Casuccio, Alessandra

doi:10.1185/03007995.2013.792247

Cited by 33 publications

(41 citation statements)

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“…According to a prevalent definition, breakthrough pain (BTP) is a transitory exacerbation of pain, severe in intensity and with a rapid onset, superimposed on an otherwise stable pain pattern in patients treated with opioids [1][2][3] . The presence of BTP has been considered as a negative prognostic factor, and influences the quality of life of these patients 4 .…”

Section: Introductionmentioning

confidence: 99%

The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen

Mercadante

Prestia

Casuccio

2013

Current Medical Research and Opinion

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Objective:The aim of this study was to prospectively assess the efficacy and safety of sublingual fentanyl (SLF) in doses proportional to opioid doses used for background analgesia for the treatment of BTP of cancer patients. Methods:A sample of patients admitted to an acute palliative care unit, presenting breakthrough pain (BTP) episodes and receiving stable doses of opioids for background pain was selected to assess the efficacy and safety of SLF used in doses proportional to the basal opioid regimen used for the management of BTP. For each patient, data from four consecutive episodes were collected. For each episode, nurses collected changes in pain intensity and adverse effects when pain got severe (T0), and 5, 10, and 15 minutes after SLF was given (T15). Results:Seventy patients were recruited for the study. The mean age was 61.7 (AE11.5). Forty-one patients were males. A total of 173 episodes of BTP were recorded (mean 2.5 episodes/patient). In 19 events, documentation regarding changes in pain intensity was incomplete. Of the 154 evaluable episodes, 143 were successfully treated (92%). Mean doses of SLF were 637 mg (SD 786), and 51 patients (72.8%) received SLF doses !800 mg. When compared to younger adult patients, older patients received significantly lower doses of FBT (p50.0005), similarly to their lower basal opioid regimen. Pain intensity significantly decreased at T5, 10 and T15 (p50.0005). The number of patients with a pain reduction of more than 33% at T5, T10, and T15 were 11, 79, and 137, respectively, and the number of patients with a reduction in pain intensity of more than 50% were 1, 21, 114 at the same intervals, respectively. No differences in changes in pain intensity for gender (p50.9) or age (p50.85) were observed. No significant changes in the number of patients reporting adverse effects of mild-moderate intensity were reported after SLF administration in comparison with baseline, and no adverse effects severe enough in intensity to require medical intervention were observed. Limitations of this study are represented by the uncontrolled design. Conclusion:This study suggests that SLF given in doses proportional to the basal opioid regimen for the management of BTP is safe and effective in clinical practice.

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Section: Introductionmentioning

confidence: 99%

The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen

Mercadante

Prestia

Casuccio

2013

Current Medical Research and Opinion

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“…From a clinical point of view, this gray area of moderate pain is commonly considered as needing a better analgesia. It has been reported that such range of pain intensity significantly interferes with daily activity and that mild pain should be considered at least ≤4/10 on a numerical pain scale [7,8]. Thus, the differences between the intensity of BTcP could be minimal (1-2 points on a numerical scale).…”

Section: Definition and Epidemiologymentioning

confidence: 98%

Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group

Mercadante

Marchetti

Cuomo

et al. 2015

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Controversies exist about the definition and epidemiology of breakthrough cancer pain (BTcP), the pharmacological treatment options, drug dosing, and how to select the medications for BTcP among the new fentanyl products. Existing data were critically evaluated to provide recommendations by an expert group. An algorithm to diagnose BTcP should be used followed by a careful assessment. Fentanyl products provide efficacy and rapidity of action to counteract the temporal pattern of BTcP. The doses of opioids used for background pain should guide the choice of the doses of fentanyl products. The choice of fentanyl products should be based on individual clinical conditions.

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“…For instance, clear differences have been found between very advanced cancer patients followed at home and unselected patients recruited in an oncologic setting, like those observed in this study [6,7]. Thus, breakthrough pain should be considered as a dynamic entity dependent on several factors, including analgesic treatment, level of physical activity, and the course of disease [8].…”

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confidence: 48%

The pain, the oncologist

Mercadante

2014

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Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

Abstract: Vol. 29, No. 6, 2013, 667-671 The different operational definitions of breakthrough cancer pain (BTcP) has generated unclear epidemiological data.

Cited by 33 publications

References 23 publications

The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen

The use of sublingual fentanyl for breakthrough pain by using doses proportional to opioid basal regimen

Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group

The pain, the oncologist

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