Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy.
Supportive/Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2020 Feb;25(2):156-160. doi: 10.1634/theoncologist.2019-0542. Epub 2019 Dec 20.
This study aimed to assess the characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain in comparison with patients receiving at least 60 mg of oral morphine equivalents (OME).
Patients with advanced cancer receiving less than 60 mg/day of OME with episodes of BTcP were included in the analysis (group L). Data were compared with patients receiving doses of opioids ≥60 mg of OME (group H). Pain intensity, current analgesic therapy, number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, and time to meaningful pain relief were collected. Adverse effects imputable to a BTcP medication were recorded.
A total of 1,418 and 2,474 patients were included in groups L and H, respectively. A lower number of BTcP episodes (p = .005), a lower BTcP intensity (p = .0001), a faster BTcP onset (p = .024), and a longer time to meaningful pain relief after taking a BTcP medication (p = .009) were found in group L as compared with group H. In group L, BTcP interference on daily activity was less than in group H (p = .009). Patients in group L were less likely to be prescribed an opioid as BTcP medication in comparison with patients in group H (p = .0001). Opioid doses used for BTcP were significantly higher in group H. Patients in group L were more likely to be less satisfied (p = .003) than patients in group H. No adverse effects of severe intensity were reported in both groups.
Patients receiving lower doses of opioids exhibit some differences in BTcP presentation: fewer episodes with lower intensity and a faster onset, a longer time to meaningful pain relief, and less satisfaction with BTcP medication. A relevant percentage of patients was receiving fentanyl preparations normally reserved for patients receiving higher doses of opioids.
Breakthrough pain is present in patients receiving low doses of opioids. It has its own peculiarities: less frequent, lower intensity, faster onset, longer time to meaningful pain relief, and less satisfaction with medication. Many patients were prescribed fentanyl preparations, which are normally reserved for patients receiving higher doses of opioids.
本研究旨在评估接受低剂量阿片类药物治疗背景疼痛的患者（BTcP）与接受至少 60 毫克口服吗啡当量（OME）的患者相比，BTcP 的特征。
纳入接受小于 60 毫克/天 OME 且出现 BTcP 发作的晚期癌症患者进行分析（L 组）。将数据与接受剂量≥60 毫克 OME 的患者（H 组）进行比较。收集疼痛强度、当前镇痛治疗、BTcP 发作次数、BTcP 强度、BTcP 可预测性和触发因素、发作持续时间、对日常生活活动的干扰、BTcP 药物、达到有意义疼痛缓解的时间。记录可归因于 BTcP 药物的不良反应。
L 组和 H 组分别纳入 1418 例和 2474 例患者。与 H 组相比，L 组的 BTcP 发作次数较少（p =.005）、BTcP 强度较低（p =.0001）、BTcP 发作时间较快（p =.024）、服用 BTcP 药物后达到有意义疼痛缓解的时间较长（p =.009）。与 H 组相比，L 组的 BTcP 对日常生活活动的干扰较小（p =.009）。与 H 组相比，L 组患者更不可能将阿片类药物作为 BTcP 药物处方（p =.0001）。H 组 BTcP 药物的阿片类药物剂量明显较高。L 组患者的满意度低于 H 组（p =.003）。两组均未报告严重强度的不良反应。
接受低剂量阿片类药物的患者在 BTcP 表现上存在一些差异：发作次数较少、强度较低、发作较快、达到有意义疼痛缓解的时间较长、对 BTcP 药物的满意度较低。相当比例的患者接受了芬太尼制剂的治疗，而这些制剂通常保留给接受高剂量阿片类药物的患者。
接受低剂量阿片类药物治疗的患者存在 BTcP。它有其自身的特点：发作频率较低、强度较低、发作较快、达到有意义疼痛缓解的时间较长、对药物的满意度较低。许多患者接受了芬太尼制剂的治疗，而这些制剂通常保留给接受高剂量阿片类药物的患者。
