Abstract
Simple SummaryThe aim of this study was to assess the prevalence and characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain. This prospective study showed that in this population, BTcP prevalence was 69.8%. Many patients did not achieve a sufficient level of satisfaction with BTcP medications, particularly with oral morphine. Data also suggest that better optimization of background analgesia, though apparently acceptable, may limit the number of BTcP episodes.The aim of this study was to assess the prevalence and characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain. A consecutive sample of advanced cancer patients receiving less than 60 mg/day of oral morphine equivalent (OME) was selected. Epidemiological data, background pain intensity, and current analgesic therapy were recorded. The presence of BTcP was diagnosed according to a standard algorithm. The number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, satisfaction with BTcP medication, and time to meaningful pain relief were collected. A total of 126 patients were screened. The mean intensity of background pain was 2.71 (1.57), and the mean OME was 28.5 mg/day (SD15.8). BTP episodes were recorded in 88 patients (69.8%). The mean number/day of BTP episodes was 4.1 (SD 7.1, range 1–30). In a significant percentage of patients, BTcP was both predictable and unpredictable (23%). The BTcP onset was less than 20 min in the majority of patients. The mean duration of untreated episodes was 47.5 (SD 47.6) minutes. The mean time to meaningful pain relief after taking a BTcP medication was >20 min in 44.5% of patients. The efficacy of BTcP medication was not considered good in more than 63% of patients. Gender (females) (OR = 4.16) and lower Karnofsky (OR = 0.92) were independently associated with BTcP. A higher number of BTcP episodes/day was associated with gender (females) (p = 0.036), short duration of BTcP (p = 0.005), poorer efficacy of BTcP medication (none or mild) (p = 0.001), and late meaningful pain relief (p = 0.024). The poor efficacy of BTcP medication was independently associated with a higher number of episodes/day (OR = 0.22). In patients who were receiving low doses of opioids, BTcP prevalence was 69.8%. Many patients did not achieve a sufficient level of satisfaction with BTcP medications, particularly with oral morphine. Data also suggest that better optimization of background analgesia, though apparently acceptable, may limit the number of BTcP episodes.
Highlights
Pain is one of the most common and feared symptoms of cancer, with a prevalence largely differing according to the stage of the disease [1]
breakthrough cancer pain (BTcP) is understood to be an episode of severe pain, of variable duration, that occurs in patients with chronic pain who are receiving a stable opioid-based analgesic regimen and who describe their baseline pain as both stable and mild to moderate in intensity for most hours of the day [6,7]
Inclusion criteria were age ≥18 years, a diagnosis of advanced cancer, the use of opioids in doses of less than 60 mg/day of oral morphine equivalent (OME) for the management of background cancer pain, and a background pain considered to be acceptable by patients, not requiring changes in opioid doses given around the clock
Summary
Pain is one of the most common and feared symptoms of cancer, with a prevalence largely differing according to the stage of the disease [1]. A variable percentage of cancer patients may develop a transitory peak of pain intensity, commonly understood as breakthrough pain (BTcP). BTcP is understood to be an episode of severe pain, of variable duration, that occurs in patients with chronic pain who are receiving a stable opioid-based analgesic regimen and who describe their baseline pain as both stable and mild to moderate in intensity for most hours of the day [6,7]. To identify BTcP, the patient must be receiving a stable opioid regimen, and baseline pain must be controlled over some period of time [13,14,15]. The presence of a precipitating event should be used to describe the subtype of BTcP as spontaneous or incident-type [6], and not to exclusively designate a BTcP. Opioids for Background Pain n oxycodone-naloxone transdermal fentanyl tapentadol codeine-paracetamol morphine oxycodone and codeine tramadol oxycodone hydroxymorphone transdermal buprenorphine oxycodone-paracetamol methadone
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