a Anesthesia and Intensive Care &Pain Relief and Palliative Care Unit , La Maddalena Cancer Center , Palermo , Italy.
Expert Rev Anticancer Ther. 2018 May;18(5):445-449. doi: 10.1080/14737140.2018.1443813. Epub 2018 Mar 16.
Breakthrough cancer pain (BTcP) is an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTcP is a heterogeneous condition as episodes vary between individuals. The aim of this article is to review the pharmacologic options for the management of BTcP. Areas covered: Recent reviews revealed that transmucosal preparations of fentanyl provided superior and more rapid pain relief as compared to placebo and oral morphine within the first 30 min after dosing. Few comparison studies among fentanyl products have been performed. Although dose titration has been recommended for years, a meaningful dosing, according to the level of opioid tolerance, may enhance the advantages of such products Expert commentary: BTcP represents a relevant problem reported by many cancer patients despite receiving regular use of opioids. Different modalities of pharmacological interventions are available. In comparison with oral opioids, fentanyl preparations appear to have a short onset and offset of analgesic effect, fitting the temporal characteristics of BTcP. Further studies are warranted to assess the net benefit of these drugs to assist decision-making by patients, clinicians, and payers, according to individual clinical conditions.
突破性癌痛 (BTcP) 是指在接受充分的阿片类药物治疗的患者中出现的剧烈疼痛，这种治疗应该能够提供至少轻度的镇痛效果。BTcP 是一种异质性疾病，因为发作在个体之间存在差异。本文的目的是回顾 BTcP 管理的药物治疗选择。
最近的综述显示，与安慰剂和口服吗啡相比，芬太尼经黏膜制剂在给药后 30 分钟内提供了更好、更快的疼痛缓解。目前还没有进行过几种芬太尼产品之间的比较研究。尽管多年来一直推荐剂量滴定，但根据阿片类药物耐受水平进行有意义的剂量调整可能会增强这些产品的优势。
尽管患者定期使用阿片类药物，但 BTcP 仍是许多癌症患者报告的一个相关问题。有多种药物治疗方法可供选择。与口服阿片类药物相比，芬太尼制剂似乎具有较短的镇痛作用起效和消退时间，符合 BTcP 的时间特征。需要进一步的研究来评估这些药物的净效益，以便根据个体临床情况，为患者、临床医生和支付方的决策提供帮助。
