Vellucci Renato, Mediati Rocco Domenico, Gasperoni Silvia, Mammucari Massimo, Marinangeli Franco, Romualdi Patrizia
Palliative Care and Pain Therapy Unit, University Hospital of Careggi, Florence.
Primary Care Unit, ASL RM 1, Rome.
J Pain Res. 2017 Sep 12;10:2147-2155. doi: 10.2147/JPR.S135807. eCollection 2017.
Breakthrough cancer pain (BTcP) is a common condition in oncological patients. However, its management is still suboptimal. Improved knowledge of BTcP and its management in clinical practice may have immediate importance for all physicians involved in the supportive care of cancer patients. This review critically discusses the most important concepts for the correct diagnosis of BTcP and presents some intriguing cases of the management of this condition in clinical practice. Overall, the most appropriate therapeutic choice appears to be a rapid-onset opioid (ROO), and in particular, the nasal route of administration is the quickest and most convenient mode of administration for the management of BTcP, especially when the patient needs rapid resolution of pain. To this end, intranasal fentanyl spray may have a particular relevance in clinical practice. Future research should focus on accepted definitions of BTcP to investigate the optimal management of this highly heterogeneous pain condition. Therapeutic decision-making of patients, clinicians, and payers will likely be driven from results of well-designed clinical trials of ROOs.
突破性癌痛（BTcP）是肿瘤患者的常见病症。然而，其管理仍不尽人意。在临床实践中，提高对BTcP及其管理的认识可能对所有参与癌症患者支持性护理的医生具有直接重要性。本综述批判性地讨论了正确诊断BTcP的最重要概念，并介绍了临床实践中处理这种病症的一些有趣案例。总体而言，最合适的治疗选择似乎是速效阿片类药物（ROO），特别是鼻内给药途径是治疗BTcP最快且最方便的给药方式，尤其是当患者需要快速缓解疼痛时。为此，鼻内芬太尼喷雾剂在临床实践中可能具有特殊意义。未来的研究应聚焦于BTcP的公认定义，以探究这种高度异质性疼痛病症的最佳管理方法。患者、临床医生和支付方的治疗决策可能会受到精心设计的ROO临床试验结果的推动。
