Pallmed Leading Sue Ryder House, Bydgoszcz, Poland.
Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland.
Pharmacol Rep. 2019 Jun;71(3):438-442. doi: 10.1016/j.pharep.2019.01.010. Epub 2019 Jan 31.
Breakthrough pain is defined as transient aggravation of pain that arises, despite well controlled or stable baseline pain. It may be preceded by known factors or occur spontaneously. Its prevalence is high and it considerably affects patients' quality of life. Therefore, proper clinical evaluation and treatment is required. Fentanyl transmucosal formulations have become the treatment of choice for spontaneous (idiopathic) episodes because of their rapid onset of action, brief period of analgesia, and easy administration via transmucosal routes. All rapid onset fentanyl formulations show better efficacy than placebo or immediate-release opioids administered via the oral route, with an onset of analgesia within 15 min. Furthermore, most patients show considerable tolerance of these fentanyl formulations, and severe side effects that can potentially be induced by opioids are rarely observed. However, the treatment of breakthrough pain should be adjusted to suit specific patient requirements. Nevertheless, particularly in predictable bursts of pain and also in spontaneous episodes of breakthrough pain with slowly intensifying pain, immediate-release formulations of opioids may play an important role.
爆发性疼痛是指尽管基础疼痛得到了很好的控制或稳定，但仍会出现短暂加重的疼痛。它可能有已知的诱发因素，也可能自发发生。其发病率较高，严重影响患者的生活质量。因此，需要进行适当的临床评估和治疗。芬太尼经黏膜制剂由于起效迅速、镇痛时间短以及可通过经黏膜途径给药，已成为自发性（特发性）发作的治疗选择。所有快速起效的芬太尼制剂与安慰剂或经口服途径给予的即释型阿片类药物相比，都具有更好的疗效，镇痛作用在 15 分钟内起效。此外，大多数患者对这些芬太尼制剂有明显的耐受性，很少观察到阿片类药物可能引起的严重副作用。然而，爆发性疼痛的治疗应根据特定患者的需求进行调整。尽管如此，在可预测的疼痛爆发和缓慢加重的自发性爆发性疼痛发作中，即释型阿片类药物可能仍发挥重要作用。
