European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology.
Cancer Clinic, St Olavs University Hospital.
Curr Opin Support Palliat Care. 2020 Jun;14(2):94-99. doi: 10.1097/SPC.0000000000000494.
An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.
The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.
All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
突破癌症疼痛（BTCP）概述，包括术语、评估、临床表现和治疗选择的固有局限性。
BTCP 的估计患病率取决于控制背景疼痛的定义界限和疼痛加剧的程度。此外，BTCP 定义之外的疼痛加剧也很普遍。在国际疾病分类第 11 次修订版中，癌症疼痛的时间特征被描述为持续的背景疼痛和间歇性发作性疼痛。BTCP 应使用经过验证的方法进行评估，并纳入患者的观点。疼痛可能与肿瘤对骨骼、内脏或神经组织的破坏有关，其特点是发病迅速、强度高、持续时间短。必须考虑针对疼痛转移灶的治疗。由于药物特性反映了疼痛特征，透黏膜芬太尼制剂对于 BTCP 的治疗非常重要。口服即释型阿片类药物可用于治疗缓慢发作或可预测的 BTCP。对于更困难的疼痛情况，可能需要使用注射或鞘内止痛药。
所有临床相关的发作性疼痛都必须根据患者的偏好进行充分治疗。透黏膜芬太尼制剂对 BTCP 有效。
