Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy.
Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental Medicine, University of L'Aquila, L'Aquila, Italy.
Oral Oncol. 2019 Aug;95:87-90. doi: 10.1016/j.oraloncology.2019.06.006. Epub 2019 Jun 11.
To characterize breakthrough pain (BTcP) in patients with Head and neck (H&N) cancer.
This was a secondary analysis of multicenter study of BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, and the mean time to meaningful pain relief after taking medication, were assessed. The presence of mucositis was also assessed.
205 patients with H&N cancer were examined. The mean number of BTcP episodes was 2.8/day, which was higher than in general population. The mean intensity of BTcP was 7.4. BTcP was more predictable in H&N cancer than in other tumors. The main trigger of predictable BTcP was the ingestion of food (76.5%). BTcP onset was fast in 148 patients (72.2%). The mean time to meaningful pain relief after taking a BTcP medication was 15.3 min and BTcP interference with daily activity was relevant in most patients (89.2%). Transdermal drugs and nasal fentanyl preparations were more frequently used for background pain and BTcP, respectively. A consistent number of patients with H&N cancer (38.5%) exhibited different levels of oral mucositis.
BTcP in patients with H&N cancer is characterized by a larger number of episodes/day and the predictability, particularly with ingestion of food. The use of drugs for background analgesia and BTcP were conditioned by the possible interference with swallowing or local mucosal damage.
描述头颈部（H&N）癌症患者的爆发性疼痛（BTcP）。
这是对 BTcP 多中心研究的二次分析。记录了背景疼痛强度和阿片类药物剂量。收集了 BTcP 发作的次数、强度、可预测性、发作时间、持续时间和对日常活动的干扰情况。评估了用于 BTcP 的阿片类药物以及服药后达到有意义的疼痛缓解的平均时间，还评估了粘膜炎的存在情况。
检查了 205 例 H&N 癌症患者。BTcP 发作的平均次数为 2.8/天，高于一般人群。BTcP 的平均强度为 7.4。BTcP 在 H&N 癌症中的可预测性高于其他肿瘤。可预测性 BTcP 的主要触发因素是进食（76.5%）。148 例患者（72.2%）BTcP 发作迅速。服药后达到有意义的疼痛缓解的平均时间为 15.3 分钟，大多数患者（89.2%）的 BTcP 对日常活动有影响。透皮药物和鼻用芬太尼制剂分别更常用于背景疼痛和 BTcP。相当数量的 H&N 癌症患者（38.5%）出现不同程度的口腔粘膜炎。
H&N 癌症患者的 BTcP 发作次数较多，可预测性较高，尤其是与进食有关。用于背景镇痛和 BTcP 的药物的使用受到吞咽或局部粘膜损伤可能的干扰的影响。
