A new focus on breakthrough cancer pain: Commentary on Davies et al.

A recent review article reports that more than one out of two patients with cancer-related pain also suffers from breakthrough pain (BTcP), however, this finding is based on several investigations with inconsistencies in the definition and assessment of the phenomenon. In the study by Davies et al., led in a sample of 1000 European BTcP patients, BTcP was defined by a unique and standardized diagnostic algorithm. A first interesting result of this study is that epidemiological and clinical aspects of BTcP (prevalence, daily numbers of episodes, time to peak, duration, interferences with daily activities) are referred to separately for the main sub-types of BTcP i.e. incident (44% of the sample) and spontaneous (42%). This is an original approach that highlights some dissimilar features—most notably peak and duration - which could imply the use of different therapeutic strategies. For instance, these observed differences could be used to determine which available rescue drugs are likely to be most effective on the basis of their different pharmacokinetic properties. Moreover, as to the treatments referred by the patients, pharmacological intervention was the preferred option in 29% of cases while a non-pharmacological option was selected by 23% of patients. That is quite surprising because a higher rate of pharmacological strategies would be expected. In parallel, other treatment options selected by patients (e.g., rest, position change, movement, heat/cold, complimentary therapies) reveals a range of solutions rarely described in clinical studies. In conclusion, the results from this study increase our knowledge of BTcP and can steer the direction of its management toward a broader spectrum of effective treatments, including non-pharmacological solutions.

DEANDREA Silvia;  CORLI Oscar; 

2014-01-21

ELSEVIER SCIENCE INC

JRC82164

0885-3924,   

https://publications.jrc.ec.europa.eu/repository/handle/JRC82164,   

10.1016/j.jpainsymman.2013.07.001,