Zeppetella G, Ribeiro M D C
St Clare Hospice, Hastingwood Road, Hastingwood, Essex, UK, CM17 9JX.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD004311. doi: 10.1002/14651858.CD004311.pub2.
Breakthrough pain is a transient increase in pain intensity over background pain. It is a common and distinct component of cancer pain that can have a negative impact for both the patient and carers' quality of life. Breakthrough pain is usually related to background pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30 minutes. At present the current approach to managing breakthrough pain is using supplemental analgesia (also known as rescue medication) at a dose proportional to the total around-the-clock (ATC) opioid dose.
This review explores and assesses the evidence for the use of opioids in the management of breakthrough pain in patients with cancer.
MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CancerLit (1993 to 2005), CINAHL (1982 to 2005) and Cochrane databases were searched. Handsearching of medical journals and reference from key textbooks was undertaken and drug companies contacted for unpublished data. There was no language restriction. Date of most recent search: January 2005.
Randomized controlled trials of opioids used as rescue medication against active or placebo comparator in patients with cancer pain were included. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, patient satisfaction and quality of life. There were no language restrictions.
Eligible studies were selected and examined independently by the two reviewers. Full text was retrieved if any uncertainty about eligibility remained. Non-English texts were screened. Quality assessment and data extraction were conducted using standardised data forms. Drug and placebo dose, titration, route and formulation were compared and detail of all outcome measures (if available) recorded.
Four studies (393 participants) met the inclusion criteria, all were concerned with the use of oral transmucosal fentanyl citrate (OTFC) in the management of breakthrough pain. Two studies examined the titration of OTFC, one study compared OTFC to normal release morphine and one study compared OTFC to placebo.OTFC was shown to be an effective treatment for breakthrough pain. When compared to placebo and morphine, participants gave lower pain intensity scores and higher pain relief scores for OTFC at all time points. Global assessment scores also favoured OTFC.
AUTHORS' CONCLUSIONS: There is evidence that OTFC is an effective treatment in the management of breakthrough pain. The randomised trial literature for the management of breakthrough pain is small and no trials were found for other opioids. Given the importance of this subject, more trials need to be undertaken.
爆发性疼痛是指疼痛强度在基础疼痛之上的短暂增加。它是癌痛中常见且独特的组成部分，会对患者和护理人员的生活质量产生负面影响。爆发性疼痛通常与基础疼痛相关，起病迅速，强度剧烈，一般为自限性，平均持续时间为30分钟。目前，处理爆发性疼痛的现行方法是使用补充镇痛药物（也称为解救药物），其剂量与全天阿片类药物总剂量成比例。
本综述探讨并评估使用阿片类药物治疗癌症患者爆发性疼痛的证据。
检索了MEDLINE（1966年至2005年）、EMBASE（1980年至2005年）、CancerLit（1993年至2005年）、CINAHL（1982年至2005年）和Cochrane数据库。对手检医学期刊和关键教科书参考文献进行了检索，并与制药公司联系以获取未发表的数据。无语言限制。最近一次检索日期：2005年1月。
纳入了使用阿片类药物作为解救药物治疗癌症疼痛患者并与活性对照或安慰剂对照进行比较的随机对照试验。所寻求的结局指标包括用适当量表测量的疼痛强度降低、不良反应、失访、患者满意度和生活质量。无语言限制。
由两位审阅者独立选择并审查符合条件的研究。如果对入选资格仍有任何疑问，则检索全文。对非英文文本进行筛选。使用标准化数据表格进行质量评估和数据提取。比较药物和安慰剂的剂量、滴定、给药途径和剂型，并记录所有结局指标的详细信息（如可得）。
四项研究（393名参与者）符合纳入标准，均涉及口服枸橼酸芬太尼（OTFC）治疗爆发性疼痛。两项研究考察了OTFC的滴定，一项研究将OTFC与普通释放吗啡进行比较，一项研究将OTFC与安慰剂进行比较。结果显示OTFC是治疗爆发性疼痛的有效药物。与安慰剂和吗啡相比，在所有时间点，OTFC组参与者的疼痛强度评分更低，疼痛缓解评分更高。整体评估评分也更倾向于OTFC。
有证据表明OTFC是治疗爆发性疼痛的有效药物。关于爆发性疼痛治疗的随机试验文献较少，未发现其他阿片类药物的试验。鉴于该主题的重要性，需要进行更多试验。
