Relationship between breakthrough cancer pain, background cancer pain and analgesic treatment – case series and review of the literature

Abstract

The assessment and treatment of breakthrough cancer pain (BTcP) remain a major challenge in medicine due to its high impact on several aspects of health-related quality of life. BTcP should be carefully monitored in all cancer care settings by a multidisciplinary team to provide an appropriate and personalized clinical approach. The aim of this paper is to provide healthcare professionals involved in cancer pain management with a review of the relevant literature on the relationship between background cancer pain and BTcP which, by definition, occurs despite adequately controlled background cancer pain. The clinical cases presented contribute to a better understanding of this issue and underline its impact in daily clinical practice. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain

Personalized Medicine in Cancer Pain Management

“…Early detection, thorough monitoring of pain intensity and etiopathogenetic features, as well as accurate evaluation of the forms of pain, are all essential. To attain optimal pain management and an improved QoL for cancer patients, they recommended a multimodal analgesic approach [ 81 ]. Masukawa and colleagues established machine learning models for CPM and discovered that the models could predict social pain, spiritual pain, and severe signs in terminally suffering cancer patients using text data from electronic healthcare records [ 82 ].…”

Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

“…Where background pain is controlled by strong opioids, BTcP should be treated with transmucosal immediate-release fentanyl (TIRF), following proper titration. 16,[45][46][47][48][49][50] Currently, the benefits of modern drug formulation technologies, 51,52 drug delivery systems, [53][54][55] and digital care options facilitate the management of cancer pain. [56][57][58][59][60][61][62] Furthermore, current evidence suggests that the most severe BTcP phenotypes are correlated with specific cancer characteristics or background pain types.…”

“…Where background pain is controlled by strong opioids, BTcP should be treated with transmucosal immediate-release fentanyl (TIRF), following proper titration. 16 , 45 – 50 …”

Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits

“… 80 – 82 The Davies algorithm 82 is normally useful for BTcP diagnosis in patients with adequately controlled background cancer-related pain in the previous week, described as no pain, or a pain intensity of ≤4/10 on a numerical scale of 0–10. 41 , 82 , 83 Careful and continuous assessment should be ensured for all patients to limit the burden of BTcP, as it is related to the patient characteristics, stage of disease and treatment. 46 , 84 Early, targeted, personalized and multimodal pain control is an important predictor of improved pain relief in patients with BTcP.…”

“… 124 Therefore, the use of a numerical scale is a simpler and objective method of assessing pain intensity during assessment and follow-up re-evaluations. 41 , 124 , 125 …”