Zucco Furio, Bonezzi Cesare, Fornasari Diego
"Presenza Amica" Association, Piazza Piemonte 4, 20145, Milan, Italy,
Adv Ther. 2014 Jul;31(7):657-82. doi: 10.1007/s12325-014-0130-z. Epub 2014 Jul 9.
Pain presents in 80% of patients with advanced cancer, and 30% have periods of increased pain due to fluctuating intensity, known as breakthrough cancer pain (BTcP). BTcP is high-intensity, short-duration pain occurring in several episodes per day and is non-responsive to treatment. The clinical approach to BTcP is variable. A review of the literature was performed to provide clinicians and practitioners with a rational synthesis of the ongoing scientific debate on BTcP and to provide a basis for optimal clinical approach to BTcP in adult Italian patients. Data show that circadian exacerbations of pain should be carefully monitored, differentiating, if possible, between fluctuations of background pain (BP), end-of-dose effect, and BTcP. BTcP should be monitored in all care contexts in clinical practice and each care facility must have all the medications and products approved for use in BTcP at their disposal. Data show that knowledge about medications for BTcP is lacking: medications for BTcP treatment are not interchangeable, although containing the same active substance; each physician must know the specific characteristics of each medication, its pharmacological properties, limitations in clinical practice, specifics relating to titration and repeatability of administration, and technical specifics relating to the accessibility and delivery. Importantly, before choosing a rapid-onset opioid (ROO), it is essential to deeply understand the status of patient and the characteristics of their family unit/caregivers, taking into account the patient's progressive loss of autonomy and/or cognitive-relational functionality. When BTcP therapy is initiated or changed, special attention must be paid to training the patient and family members/caregivers, providing clear instructions regarding the timing of drug administration. The patient must already be treated effectively with opioids before introducing ROOs for control of BTcP.
80%的晚期癌症患者会出现疼痛，30%的患者会因疼痛强度波动而经历疼痛加剧期，即爆发性癌痛（BTcP）。BTcP是高强度、短持续时间的疼痛，每天发作数次，且对治疗无反应。BTcP的临床处理方法各不相同。进行了一项文献综述，为临床医生和从业者提供关于BTcP正在进行的科学辩论的合理综合，并为意大利成年患者BTcP的最佳临床处理方法提供依据。数据表明，应仔细监测疼痛的昼夜加剧情况，尽可能区分背景疼痛（BP）波动、剂量末期效应和BTcP。在临床实践的所有护理环境中都应监测BTcP，每个护理机构必须备有所有批准用于BTcP的药物和产品。数据表明，缺乏关于BTcP药物的知识：用于BTcP治疗的药物不可互换，尽管含有相同的活性物质；每位医生必须了解每种药物的具体特性、其药理特性、临床实践中的局限性、与给药滴定和重复性相关的细节以及与可及性和给药方式相关的技术细节。重要的是，在选择速效阿片类药物（ROO）之前，必须深入了解患者的状况及其家庭单位/护理人员的特征，同时考虑患者自主能力和/或认知关系功能的逐渐丧失。当开始或改变BTcP治疗时，必须特别注意对患者以及家庭成员/护理人员进行培训，提供关于给药时间的明确说明。在引入ROO以控制BTcP之前，患者必须已经接受有效的阿片类药物治疗。
