意大利肿瘤疼痛调查（IOPS）：一项在意大利多中心开展的、针对不同环境下爆发性疼痛的研究。

Italian Oncological Pain Survey (IOPS): a multicentre Italian study of breakthrough pain performed in different settings.

作者信息

Mercadante Sebastiano, Lazzari Marzia, Reale Carlo, Cuomo Arturo, Fusco Flavio, Marchetti Paolo, Mediati Rocco D, Chiurazzi Bruno, Ciuffedra Libero, Caraceni Augusto, Iaffaioli Vincenzo, Luzzani Massimo, Micheletto Giuseppe, Papa Alfonso, Raffaeli William, Valle Alessandro, Caruso Michele, Di Costanzo Francesco, Pinato Gianpaolo, Nardi Filippo, Barni Sandro, Natoli Silvia, Mammucari Massimo, Sabato Alessandro F, Dauri Mario

机构信息

*Anesthesia and Intensive Care & Pain Relief and Supportive Care, La Maddalena Cancer Center, Palermo †Emergency Care, Critical Care Medicine, Pain Medicine and Anesthesiology Department, Tor Vergata University of Rome ‡Anesthesiology, Resuscitation, and Pain Therapy Department, Umberto I Hospital ¶Molecular and Clinical Medicine Medical Oncology, La Sapienza University of Rome #IDI-IRCCS ‡‡‡‡Primary Care, ASL RM F, Rome §Anesthesiology, Resuscitation, and Pain Therapy Department ¶Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale ††Medical Oncology, A.O.R.N "A. Cardarelli" Hospital †††Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples ∥Palliative Care ASL3, Genoa ##Palliative Care, Gerontology and Physical Education Department, E.O. Galliera Hospitals, Genoa **Pain Relief, Palliative Care, Oncology Department, Careggi Hospital, Florence ‡‡Hematology Oncology Center Subalpine (COES), A.O. City Health and Science, Molinette §§§Palliative Care, FARO Foundation, Turin §§IRCCS Foundation National Cancer Institute of Milan, Milan ***Palliative Care, Pain Relief, ASL 13 Mirano Veneto Region ‡‡‡Palliative Care, Pain Relief, Infermi Hospital, Rimini ∥∥∥Medical Oncology, Humanitas Oncology Center of Catania, Catania ¶¶¶Medical Oncology 1, Careggi Hospital, Florence ###Pain Relief, IRCCS Veneto Oncological Institute, Padua ****Pain Relief, Palliative Care, AV3 Macerata Hospital, Macerata ††††Medical Oncology A.O. Treviglio, Bergamo, Italy ∥∥European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway.

出版信息

Clin J Pain. 2015 Mar;31(3):214-21. doi: 10.1097/AJP.0000000000000161.

DOI:10.1097/AJP.0000000000000161

PMID:25654429

Abstract

OBJECTIVE

A survey of breakthrough pain (BTP) was performed in five palliative care units (PCU), seven oncology departments (ONC), and nine pain clinics (OPC).

METHODS

A standard algorithm was used to confirm the diagnosis of BTP of patients refereed to different settings.

RESULTS

1,412 evaluable cancer patients were enrolled. 53.9% were males and the mean age was 63.7±13.1 years. The mean intensity of background pain was 2.8±0.73. Patients reported 2.4±1.1 BTP episodes/day with a mean intensity of 7.37±1.28. 80.6% patients reported that the BTP had a significant negative impact in everyday life. The majority of patients reported a fast onset of BTP, which was predictable in 50.7% of cases, while BTP with a gradual onset (>10 min) was less predictable (29%) (P=0.001). PCU patients were older, had lower Karnofsky levels, a lower number of BTP episodes/day, a slow onset of BTP onset, and a less predictable BTP. Cancer diagnosis was performed a mean of 23.5 months (SD±32.8) before the assessment. The mean duration of background pain was 3.5 months (SD±3.5), and the mean duration of any analgesic treatment was 2.5 months (SD±3). BTP started a mean of 2.2 months (SD±1.9) before the assessment. Characteristics of BTP were influenced by the course of disease, as well as the duration of background pain and initiation of BTP. Most patients took rapid onset opioids and were satisfied with the treatment. BTP diagnosis was prevalently made by ONC and OPC physicians, and rarely by GPs.

CONCLUSION

This survey performed by an Italian observatory expert review group, has confirmed that the BTP represents a clinically relevant condition with a negative impact on the patient's quality of life. BTP was detected in all settings involved. A number of factors are associated with the BTP. Also factors regarding the course of disease and setting of care have been assessed. This information may help in stratifying patients or predicting the risk of development of BTP with specific characteristics.

摘要

目的

在五个姑息治疗单元（PCU）、七个肿瘤科（ONC）和九个疼痛门诊（OPC）开展了一项关于爆发性疼痛（BTP）的调查。

方法

采用标准算法对转诊至不同机构的患者进行BTP诊断确认。

结果

共纳入1412例可评估的癌症患者。其中男性占53.9%，平均年龄为63.7±13.1岁。背景疼痛的平均强度为2.8±0.73。患者报告每天有2.4±1.1次BTP发作，平均强度为7.37±1.28。80.6%的患者报告BTP对日常生活有显著负面影响。大多数患者报告BTP发作迅速，50.7%的病例可预测，而发作缓慢（>10分钟）的BTP较难预测（29%）（P=0.001）。PCU患者年龄较大，卡诺夫斯基评分较低，每天BTP发作次数较少，BTP发作缓慢且较难预测。癌症诊断在评估前平均23.5个月（标准差±32.8）进行。背景疼痛的平均持续时间为3.5个月（标准差±3.5），任何镇痛治疗的平均持续时间为2.5个月（标准差±3）。BTP在评估前平均2.2个月（标准差±1.9）开始发作。BTP的特征受疾病进程、背景疼痛持续时间和BTP发作起始时间的影响。大多数患者使用起效迅速的阿片类药物并对治疗满意。BTP诊断主要由ONC和OPC医生做出，全科医生很少做出诊断。