Diagnosis Of Breakthrough Pain Research Articles

Pharmacotherapy of breakthrough pain, what else can we do to improve the effectiveness of treatment

Breakthrough pain in cancer patients (BTP), also called episodic or incidental, occurs in a significant percentage of patients (40–60%) with cancer. Compared to patients who did not have BTP, patients with a diagnosis of breakthrough pain more often show functional disorders, a higher level of anxiety and depression, and a much worse quality of life. What’s more, in this group of patients, the consumption of sleeping pills and other groups of psychotropic drugs increases, which in turn can lead to a decrease in the effectiveness of analgesic therapy and escalate the risk of adverse interactions with analgesics. The key to improving effectiveness and reducing complications is the choice of drugs used to treat pain breakthrough so that the pharmacokinetic profile of the selected drug is compatible with the breakthrough pain characteristics.

Evaluation of the quality of care of elderly patients with chronic and breakthrough pain treated with opioids: SAND study

Objective: The objective of this study was to evaluate the quality of care of elderly patients with treatment for chronic pain (CP) and breakthrough pain (BTP).Methods: A cross-sectional observational study was conducted in 20 pain units, selecting patients aged 70 years or older with baseline controlled CP in treatment with opioids and a diagnosis of BTP. Patients were classified as first episode of BTP or patient in follow-up. The patients completed the SF-12 quality of life questionnaire, Brief Pain Inventory, Lattinen Index, and Edmonton Symptoms Assessment Scale. The patient’s satisfaction with the treatment was evaluated through a visual analogue scale (VAS).Results: A total of 199 patients were included with 67.7% women (132). There were 28.5% (55) attending the first visit for BTP and 71.5% (138) were on follow-up visits. On the physical component of the SF-12, 95% had a score below the mean for the Spanish general population and 44% had a score below the mean on the mental component. Worse scores were observed for women in the bodily pain dimension (p = .032) and in the overall physical component (p = .045). There were 62.9% (112) patients satisfied with the treatment for BTP. In the multivariate analysis, SF-12 physical component scores (p = .017) and patient’s satisfaction with BTP treatment was better in follow-up visits (p = .031).Conclusions: All clinical parameters compared between first visit for the treatment of BTP and follow-up visits were improved, so the quality of care was also considered improved. Elderly women and non-oncologic patients were observed to be the population with worse symptom control.

Chinical diagnosis and therapy of breakthrough pain in cancer patients

Blackground Breakthrough pain (BTP) is a transient exacerbation of pain with moderate and severe intensity and has high incidence in patients with cancer. Breakthrough pain lacks a consensus international definition and diagnosis standard,and clinical treatment of which is subsequently inadequate. Therefore it is difficult to manage breakthrough pain in patients with cancer. Objective This article is to summed up the newest development about the diagnosis and treatment of breakthrough pain in order to provide the evidence for clinical management. Content The diagnosis of breakthrough pain includes definition,epidemiology, classification and evaluation. However, management of breakthrough pain involves pharmacological and nonpharmacological treatment. Trend The most common therapy of breakthrough pain is administration of short and quick analgesics. However, the ideal management of breakthrough pain may require a combination of pharmacological with nonpharmacological treatment strategies. Key words: Cancer; Breakthrough pain; Diagnosis; Management

Breakthrough Pain in Cancer Patients— Characteristics, Impact, and Assessment

Breakthrough pain (brief flares of severe pain superimposed on baseline pain) is a common problem in patients with cancer and is associated with significant physical, psychologic and economic burdens on patients and carers. The successful management of breakthrough pain is dependent on the accurate diagnosis and adequate assessment of the patient, which in turn leads to appropriate and effective treatment. It is clear that the impact of breakthrough pain on patients is wide ranging, affecting patient quality of life, decreasing physical functioning, and often leading to psychologic consequences, such as anxiety and depression. A structured and appropriate approach to the assessment and diagnosis of breakthrough pain needs to be comprehensive to identify all the areas of impact on a patient’s life. In this article, cancer breakthrough pain is defined and the different subtypes of breakthrough pain are explained. Assessment tools that are frequently used to appropriately assess the effects of breakthrough pain are discussed and treatment options after diagnosis are also outlined, with a focus on non-pharmacologic interventions.

Recognition and Diagnosis of Breakthrough Pain

To review major clinical issues related to recognition and diagnosis of breakthrough pain. Persistent pain and breakthrough pain (BTP) are distinct clinical entities that should be recognized, diagnosed, and treated individually. BTP is common in patients with cancer and a variety of other chronic diseases. Reported incidence of BTP varies widely from 16% to 95% of those with persistent pain syndromes. Such variability is likely due to lack of a clear consensus on the definition of BTP. It is most commonly defined as an abrupt, short-lived, and intense pain that "breaks through" the around-the-clock analgesia that controls persistent pain. The three subtypes of BTP are incident, idiopathic, and end-of-dose failure. BTP also is categorized as somatic, visceral, neuropathic, or mixed. Appropriate assessment of the patient takes into consideration source, severity, pattern, subtype, and cause of pain. Successful treatment is important because BTP has a profound impact on the patient's quality of life, as well as cost of health care. BTP is likely to be underdiagnosed and undertreated because of the lack of consensus on its definition and unwarranted concerns among health care professionals and patients about overmedicating. Additionally, and for reasons not entirely clear, many physicians and other health care providers place a low priority on pain management and underrecognize the occurrence of BTP in patients with persistent pain. Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients.

An international survey of cancer pain characteristics and syndromes

The optimal assessment of cancer pain includes a detailed description of pain characteristics and classification by both syndrome and likely mechanisms. In the clinical setting, the interpretation of this information is aided by knowledge of the available clinical experiences on these aspects of the pain. Unfortunately, existing data are limited. There have been few large surveys of cancer pain characteristics and syndromes, and comparative data from patients in different parts of the world are entirely lacking. To better define the characteristics of cancer pain syndromes the Task Force on Cancer Pain of the International Association for the Study of Pain (IASP) conducted a prospective, cross-sectional, international, multicenter survey of pain specialists and their patients. From a total of 100 clinicians who described themselves as cancer pain practitioners in the IASP membership directory, 51 agreed to participate in the survey and a total of 58 provided data. These clinicians resided in 24 countries and evaluated a total of 1095 patients with severe cancer pain mostly requiring opioid medication, using a combination of patient-rated and observer-rated measures. The patient-rated scales comprised a pain intensity measure chosen from the brief pain inventory. The observer-rated information included demographic and tumor-related data, and responses on checklists of pain syndromes and pathophysiologies. Patients were heterogeneous in terms of demographics and tumor-related information. More than 76% had a Karnofsky performance status score ≤70. Almost one-quarter of the patients experienced two or more pains. A large majority of the patients (92.5%) had one or more pains caused directly by the cancer; 20.8% of patients had one or more pains caused by cancer therapies. The average (SD) duration of pain was 5.9 (10.5) months. Approximately two-thirds of patients (66.7%) reported that the worst pain intensity during the day prior to the survey was ≧7 on a 10-point numeric scale. The factors that were univariately associated with higher pain intensity included the presence of breakthrough pain, somatic pain or neuropathic pain, age younger than 60 years, and lower performance status score. A multivariate model suggested that the presence of breakthrough pain, somatic pain, and lower performance status were the most important predictors of intense pain. Pains that were inferred by the treating clinician to be nociceptive and due to somatic injury occurred in 71.6% of the patients. Pains labeled nociceptive visceral were noted in 34.7% and pains inferred to have neuropathic mechanisms occurred in 39.7%. In a broad classification, the major pain syndromes comprised bone or joint lesions (41.7% of patients), visceral lesions (28.1%), soft tissue infiltration (28.3%), and peripheral nerve injuries (27.8%). Twenty-two types of pain syndromes were most prevalent. Large differences in the diagnosis of breakthrough pain by clinicians of different countries suggest that this phenomenon is either defined or recognized differently across countries. These data confirm, in segment of the cancer population experiencing severe pain, in different parts of the world, that cancer pain characteristics, syndromes and pathophysiologies are very heterogeneous. Predictors of worsening pain can be identified. The data provide a useful context for the interpretation of pain-related information acquired in both clinical and research settings. They suggest the need for future studies and the potential usefulness of a written checklist for cancer pain syndromes and pathophysiologies.