scholarly journals Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients

Cancers ◽  
2018 ◽  
Vol 10 (6) ◽  
pp. 175 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Paolo Marchetti ◽  
Arturo Cuomo ◽  
Augusto Caraceni ◽  
Rocco Mediati ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Cancer Patients ◽  
Clinical Presentation ◽  
Breakthrough Pain ◽  
Fast Onset ◽  
Long Duration ◽  
Background Pain ◽  
Different Characteristics ◽  
Interdependent Relationships ◽  
Variable Presentation

Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics.

Introduction

2019 ◽  
pp. 1-8
Author(s):  
Andrew Davies
Keyword(s):  
Cancer Patients ◽  
Healthcare Professionals ◽  
Breakthrough Pain ◽  
Heterogeneous Condition ◽  
Long Duration ◽  
Background Pain

Breakthrough pain is a transient exacerbation of pain that occurs despite relatively stable and adequately controlled background pain. Breakthrough pain is a common and heterogeneous condition. It is a significant cause of morbidity. The focus of this book is on cancer-related breakthrough pain in adults. Background pain refers to ‘constant or continuous pain of long duration’. However, breakthrough pain has been described as: ‘a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain’. It can be spontaneous or incident related and is common in cancer patients, with around 60% being affected. Breakthrough pain is a major challenge to healthcare professionals (as well as to their patients).

scholarly journals Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients

2012 ◽  
Vol 29 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Claudio Adile ◽  
Riccardo Torta ◽  
Antonella Varetto ◽  
Fabio Fulfaro ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Breakthrough Pain ◽  
Advanced Cancer Patients

Switching from high doses of pure µ-opioid agonists to transdermal buprenorphine in patients with cancer: A feasibility study

2013 ◽  
Vol 9 (4) ◽  
pp. 255-262 ◽  
Author(s):  
Lena Lundorff, MD ◽  
Per Sjøgren, DmSci, MD ◽  
Ole Bo Hansen, MD ◽  
Torsten Jonsson, MD ◽  
Per Rotbøll Nielsen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Breakthrough Pain ◽  
Brief Pain Inventory ◽  
Self Assessment ◽  
Opioid Agonists ◽  
Before And After ◽  
High Doses ◽  
The Individual

Background: Several myths on buprenorphine’s pharmacology exist: possible analgesic ceiling effect, feasibility of combination with other opioid agonists, and the reversibility of side effects. Aim to evaluate: 1) if cancer patients receiving high doses of pure agonists could obtain adequate pain relief after switching to transdermal (TD) buprenorphine and 2) whether the numbers of breakthrough pain episodes after switching increased and whether they could be treated with the same doses of pure agonist as before switching.Design: The prospective open multicenter study included outpatients with moderate-to-severe cancer pain satisfactorily controlled.Setting: Patients were switched from the usual pure agonist to TD buprenorphine and were titrated to a stable dose. The assessments were: 1) daily self-assessment of pain intensity, numbers of rescue medications, and pain interference with sleep; 2) brief pain inventory; 3) pain relief and pain intensity; 4) quality of life; and 5) adverse events and symptoms.Results: Eighteen patients receiving 150-516 mg of morphine/day were included. The buprenorphine dose at the end of the study varied between 52.5 and 140 mg/h. No difference in pain before and after switching was shown. The level of rescue doses was maintained. The patches were well tolerated. A significant decrease in fatigue and an increase in global health status were seen after the switch.Conclusion: It is feasible to switch cancer patients from high doses of pure µ- opioid agonists to TD buprenorphine without eliciting any antagonist effects, but the dose conversion factor is individual and the switching process should be tailored for the individual patient.

Factors influencing the analgesic response over time of the oxycodone-naloxone association in painful cancer patients: GREAT study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10089-10089
Author(s):  
Oscar Corli ◽  
Lorenzo Legramandi ◽  
Mirko Marabese ◽  
Anna Roberto
Keyword(s):  
Pain Intensity ◽  
Cancer Patients ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Analgesic Efficacy ◽  
Average Pain ◽  
Numerical Rating ◽  
Analgesic Response ◽  
Over Time

10089 Background: The prolonged use of opioids is usually associated with the appearance of adverse events as drowsiness, constipation, nausea/vomiting, and dizziness. Some effects are self-limiting over time for the onset of tolerance while others, as constipation, persist. Clinical studies demonstrated that the association oxycodone-naloxone (OXN), reduced the constipation in the presence of unchanged analgesic efficacy. Though, the variability of the analgesic response to OXN is not explained yet. The aim of this study was to evaluate the association between the clinical and genetics factors and analgesics response at OXN. Methods: In this study the cancer patients with moderate to severe pain received OXN and followed for 28 days. At each visit pain intensity modifications of therapy and adverse drug reactions (ADRs) were recorded. The primary efficacy endpoint was the proportion of responders, defined as patients with a decrease of the average pain intensity from baseline to last visit ≥30% and a final average pain score≤4, measured on 0-10 numerical rating scale. Genetic tests to identify SNPs related to opioid response were performed in each patient. Results: 14 centers participated in the study and recruited 206 patients. Among 176 patients analyzed for a primary endpoint the mean age was 68 (SD 10); 56% were male. Average and worst pain intensity decreased from baseline to last visit from 6.2 to 2.9 and from 8.3 to 4.6 respectively. 81% of patients were responders. Digestive system tumors (p = 0.05), concomitant thyroid endocrinopathy (p = 0.023), psychological irritability (p = 0.0029) and breakthrough pain at baseline were found to decrease the risk of positive response. None of the investigated polymorphisms influenced the analgesic response. Moderate to severe intensity ADRs were mainly constipation (26%), drowsiness (19%) and dry mouth (12%). Conclusions: In patients with moderate to severe cancer pain, OXN showed a strong analgesic effect (about 50% pain reduction). In comparison with other studies the induced constipation appears substantially lower. Some clinical factors influence the analgesic response while none genetic polymorphisms modulate the response. Clinical trial information: NCT02293785.

scholarly journals Breakthrough Pain in Patients with Lung Cancer. A Secondary Analysis of IOPS MS Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1337
Author(s):  
Sebastiano Mercadante ◽  
Francesco Masedu ◽  
Marco Valenti ◽  
Federica Aielli
Keyword(s):  
Lung Cancer ◽  
Pain Intensity ◽  
Breakthrough Pain ◽  
Secondary Analysis ◽  
Lung Cancers ◽  
Future Studies ◽  
Opioid Dose ◽  
Background Pain ◽  
The Mean ◽  
Mean Time

Aim: To characterize breakthrough cancer pain (BTcP) in patients with lung cancer. Methods: This was a secondary analysis of multicenter study of patients with BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, the mean time to meaningful pain relief after taking medication, satisfaction and adverse effects were assessed. Results: 1087 patients with lung cancer were examined. In comparison with other tumors, patients with lung cancer showed: higher background pain intensity (p = 0.006), lower opioid doses (p = 0.005), higher intensity of BTcP (p = 0.005), movement (79.5%) and cough (8.2%), as principal triggers for predictable BTcP (p < 0.009), larger BTcP interference with daily activity (p = 0.0001), higher use of adjuvants (p = 0.0001). No relevant differences in the other parameters examined were found. Conclusion: Patients with lung cancer have their own peculiarities, including higher basal and BTcP pain intensity and the use of more adjuvant drugs for background pain. The most frequent triggers for predictable BTcP are movement and cough. Future studies should be performed to analyze the prevalence of BTcP in patients with different lung cancers as well as the optimal management strategy for background pain and BTcP.

Management of breakthrough pain in cancer patients

2018 ◽  
Vol 1 (42) ◽  
pp. 34
Author(s):  
Roxana-Andreea Rahnea-Niţă ◽  
Gabriela Rahnea-Niţă ◽  
I. Duluta ◽  
Mădălina Colef ◽  
Anda Natalia Ciuhu
Keyword(s):  
Cancer Patients ◽  
Breakthrough Pain

scholarly journals PO-56 Relationship between clinical presentation of SARS-CoV-2 infection and risk of thromboembolic events and prognosis in cancer patients

2021 ◽  
Vol 200 ◽  
pp. S45-S47
Author(s):  
J.L. Catoya Villa ◽  
A. Gutiérrez Ortiz de la Tabla ◽  
D.S. Juliao Caamaño ◽  
C. López Jiménez ◽  
C. Blanco Abad ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Presentation ◽  
Thromboembolic Events

scholarly journals Comparison of the clinical effectiveness of treatments for aromatase inhibitor-induced arthralgia in breast cancer patients: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033461
Author(s):  
Kyeore Bae ◽  
Si Yeon Song
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Pain Intensity ◽  
Aromatase Inhibitor ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Secondary Outcome ◽  
Breast Cancer Patients ◽  
Patient Reported

IntroductionAromatase inhibitor-induced arthralgia (AIA) is a major adverse event of aromatase inhibitors (AIs) and leads to premature discontinuation of AI therapy in breast cancer patients. The objective of this protocol for a systematic review and network meta-analysis (NMA) is to provide the methodology to compare the change in pain intensity between different AIA treatments and demonstrate the rank probabilities for different treatments by combining all available direct and indirect evidence.Methods and analysisPubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE, Web of Science and ClinicalTrials.gov will be searched to identify publications in English from inception to November 2019. We will include randomised controlled trials (RCTs) assessing the effects of different treatments for AIA in postmenopausal women with stage 0–III hormone receptor-positive breast cancer. The primary endpoints will be the change in patient-reported pain intensity from baseline to post-treatment. The number of adverse events will be presented as a secondary outcome.Both pairwise meta-analysis and NMA with the Frequentist approach will be conducted. We will demonstrate summary estimates with forest plots in meta-analysis and direct and mixed evidence with a ranking of the treatments as the P-score in NMA. The revised Cochrane risk-of-bias tool for randomised trials will be used to assess the methodological quality within individual RCTs. The quality of evidence will be assessed.Ethics and disseminationAs this review does not involve individual patients, ethical approval is not required. The results of this systematic review and NMA will be published in a peer-reviewed journal. This review will provide valuable information on AIA therapeutic options for clinicians, health practitioners and breast cancer survivors.PROSPERO registration numberCRD42019136967.

Sign in / Sign up

Export Citation Format

Share Document