Payne Richard
Duke Institute on Care at the End of Life, Duke University Divinity School, Durham, North Carolina 27708, USA.
Pain Med. 2007 Jan-Feb;8 Suppl 1:S3-7. doi: 10.1111/j.1526-4637.2006.00269.x.
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.
回顾与突破性疼痛的识别和诊断相关的主要临床问题。
持续性疼痛和突破性疼痛（BTP）是不同的临床实体，应分别予以识别、诊断和治疗。BTP在癌症患者和多种其他慢性疾病患者中很常见。报告的BTP发生率差异很大，在持续性疼痛综合征患者中从16%到95%不等。这种差异可能是由于对BTP的定义缺乏明确的共识。它最常被定义为一种突然、短暂且强烈的疼痛，“突破”了控制持续性疼痛的全天候镇痛。BTP的三种亚型为偶发性、特发性和剂量末期失效性。BTP也可分为躯体性、内脏性、神经性或混合性。对患者进行适当评估时要考虑疼痛的来源、严重程度、模式、亚型和原因。成功的治疗很重要，因为BTP对患者的生活质量以及医疗保健成本都有深远影响。由于对其定义缺乏共识，以及医疗保健专业人员和患者对过度用药存在不必要的担忧，BTP可能未得到充分诊断和治疗。此外，由于一些尚不完全清楚的原因，许多医生和其他医疗保健提供者对疼痛管理的重视程度较低，未能充分认识到持续性疼痛患者中BTP的发生。
对癌症和非恶性疾病中BTP有更多的了解和认识，将有助于改善对BTP的识别和诊断，并最终为这些患者带来更有效的治疗和更高的生活质量。
