Careful individualized analgesic therapy improves management of breakthrough pain (BTP) in cancer patients

摘要

Breakthrough pain (BTP) in cancer patients is often inadequately diagnosed and treated. Careful patient assessment and individualized analgesic therapy are necessary to improve BTP treatment. Optimal BTP therapy can be achieved by treating the underlying cause of pain with adjuvant therapies, optimizing baseline analgesia and using pain-type specific analgesics.Pain is a common problem in patients with cancer. It affects 30-40% of patients at diagnosis, 50-70% of patients on active treatment and 70-80% of patients with advanced disease. Although the treatment of baseline pain has improved in the recent years, the management of breakthrough pain (BTP) remains a challenge with an estimated prevalence of 65%. BTP has been broadly defined by Svendsen et al. as "episodic flares of pain on a treated or untreated baseline pain", and may be classified as:1 end-of-dose failure (affects 17-30% of patients), which is characterized by uncontrolled baseline pain that requires further titration to establish control; 2 incident pain (affects 50-60% of patients), which results from a precipitating event following controlled baseline pain, and may be further divided into predictable incident pain (caused by anticipated stimuli, such as movement, swallowing or touching) or unpredictable incident pain (caused by involuntary or visceral [e.g. colic or ischaemic] events); 3 idiopathic/spontaneous pain (affects 20-60% of patients), which occurs in cases of controlled baseline pain without a precipitating cause (e.g. neuropathic pain).