Assessment and treatment of irruptive cancer pain
Keywords:
Breakthrough Cancer Pain, BTCP, oncologic pain, pain treatment, morphine, fentanylAbstract
The breakthrough cancer pain (BTCP) consists of a transitory exacerbation of pain that occurs either spontaneously or triggered by a specific factor (predictable or unpredictable), despite the relatively stable and adequate control of the background pain. It is essential to clearly identify that it is an episode of BTP and not a poorly controlled chronic pain.
Pharmacological treatment can consist of rescue medication - Short Acting Opioid - SAO (eg. Sevredol®, Oramorph®) and Rapid Opioid Onset - ROO such as sublingual fentanyl sublingual, buccal film and transmucosal (eg. Abstral®, Breakyl® and Actiq®).
It is essential nurses know how to make a proper assessment of BTP, how to teach the patient to manage the therapeutic regimen and how to reassess. The objectives of the reassessment determine the efficacy and tolerability of treatment of BTP and any change in its nature. Improper reassessment could lead to the continuation of an ineffective and/or inappropriate treatment.
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References
Ripamonti, C.I. et al (2012). Management of cancer pain: ESMO Clinical Practice Guidelines. Annals of Oncology, 23 (Suppl 7), vii39-vii154.
Portenoy RN, Hagen NA (1990). Breakthrough pain: definition, prevalence and characteristics. Pain, 41(3), 273-281.
Zepetella, G (2011). Breakthrought pain in cancer patients. Clinical Oncology, 23, 393-398.
Davies A, Dickman A, Reid C, Stevens AM, Zeppetella G. (2009). The management of cancer-related breakthrough pain: recommendations
of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. European Journal of Pain, 13, 331-338.
Caraceni A, et al. (2012).Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet
Oncology, 13, 58-68.
Hjermstad M, Fainsinger R, Kaasa S. (2009). Assessment and classification of cancer pain. Current Opinion in Supportive and Palliative Care, 3, 24-30.
Mercadante S, et al (2013). Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study
for a better interpretation of epidemiological and clinical studies. Current Medical Research & Opinion, 29(6), 667-671.
Davies A. (2006). Cancer-related breakthrough pain. Oxford: Oxford University Press,.
Margarit C, et al (2012). Breakthrough cancer pain – still a challenge. Journal of Pain Research, 5, 559-566.
Ali G, Kopf A. (2010). Breaktrough pain, the pain emergency, and incident pain. In: International Association for Study of Pain. Guide to pain management in low-resource settings. Seattle: IASP, 277-282.
Portenoy RK (1997). Treatment of temporal variations in chronic cancer pain. Seminars in Oncology, 5 (Suppl 16), 7-12.
Davies A, Vriens J, Kennett A, McTaggart M. (2008). An observational study of oncology patients’ utilisation of breakthrough pain medication. Journal of Pain and Symptom Management, 35(4), 406-11.
Davies A, Zeppetella G, Andersen S, et al (2011). Multi-centre European study of breakthrough cancer pain: pain characteristics and patient
perceptions of current and potencial management strategies. European Journal of Pain, 15(7), 756-763.
Swanwick M, Haworth M, Lennard RF (2001). The prevalence of episodic pain in cancer: a survey of hospice patients on admission. Palliative
Medicine, 15 (1), 9-18.
Caraceni, A. et al (2013). Guidelines for the Management of Breakthrough Pain in Patients With Cancer. Journal of the National Comprehensive Cancer Network. Volume 11 Supplement 1 – March S29- S36
Wengström, Y; Geerling, J., Rustøen, T. (2014). European Oncology Nursing Society breakthrough cancer pain guidelines. European Oncology Journal of Oncology Nursing, April, 18 (2), 127 – 131.
Associação de Enfermagem Oncológica Portuguesa: Dor irruptiva oncológica - Guidelines 2013 - Guia de bolso. Consultado em 14 de Fevereiro de 2015. Disponível em:http://www.aeop.net/sgc/Plugins/Uploads/files/DIO_guidelines2013_11mar%20%20revisao%20final%2012%20marco.pdf
Hagen NA, Stiles C, Nckolaichuk C, et al (2008). The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a Delphi process and patient think-aloud interviews. Journal of Pain Sympton Management, 35, 136-152.
Zeppetella, G.; Ribeiro, MD (2002). Episodic pain in patients with advanced cancer. American journal Of hospice and Palliative Care, 19, 267-76.
Webber, K.; Davies, AN; Cowie, MR (2010). Development of the Breakthrough Pain Assessment Tool (BAT). In Proceedings of the 13th World Congress on Pain. 29 august – 2 september, Montreal, Canada.
WHO Expert Committee (1996). Cancer pain relief. World Health Organization, Geneva.
Christie JM, Simmonds M, Patt R, Coluzzi P, Busch MA, Nordbrock E, et al (1998). Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain. Journal of Clinical Oncology, 16, 3238-45.
Portenoy RK, Payne R, Coluzzi P, Raschko JW, Lyss A, Busch MA, et al (1999). Oral transmucosal fentanyl citrate (OTFC) for the treatment of
breakthrough pain in cancer patients: a controlled dose titration study. Pain, 79: 303-12.
Coluzzi PH, Schwartzberg L, Conroy Jr JD, Charapata S, Gay M, Busch MA, et al (2001). Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain, 91, 123-30.
Portenoy RK, Taylor D, Messina J, Tremmel L. (2006). A randomized, placebo-controlled study of fentanyl buccal tablet for breakthrough pain in opioid-treated patients with cancer. Clinical Journal of Pain, 22, 805-11.
Slatkin NE, Xie F, Messina J, Segal TJ. (2007). Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. Journal of Support Oncology, 5, 327-34.
Hanks GW, De Conno F, Cherny N et al (2001). Morphine and alternative opioids in cancer pain: the EAPC recommendations. British Journal of
Cancer, 84, 587-593.
Mercadante S, Villari P, Ferrera P, et al. (2006). Safety and effectiveness of intravenous morphine for episodic breakthrough pain in patients
receiving transdermal buprnorphine. J Pain Symptom Manage 2006; 32, 175-179.
Payne R, Coluzzi P, Hart L, et al. (2001). Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. Journal of Pain Symptom Management, 22(1), 575-83.
INFARMED – RCM AbstraL (2014). Consultado em 17 de Fevereiro de 2015, em
http://www.infarmed.pt/infomed/download_ficheiro.php?med_id=42339&tipo_doc=rcm
INFARMED – RCM Actiq (2012). Consultado em 17 de Fevereiro de 2015,
em http://www.infarmed.pt/infomed/download_ficheiro.php?med_id=31844&tipo_doc=rcm
INFARMED – RCM Breakyl (2014). Consultado em 17 de Fevereiro de 2015, em
http://www.infarmed.pt/infomed/download_ficheiro.php?med_id=46885&tipo_doc=rcm
INFARMED – GUIA DO PRESCRITOR ABSTRAL - Versão 2, Janeiro de 2015 - Consultado em 19 de Fevereiro de 2015,
Perdigão, Carlos (2012). Gestão do Risco dos Medicamentos - Interacção da toranja com diversos fármacos de uso corrente. Revista
Factores de Risco, nº 27 OUT-DEZ pág. 53.
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