Main Regional Centre for Pain Relief and Palliative Care Unit, La Maddalena Cancer Centre, Via San Lorenzo 312, 90146, Palermo, Italy.
Regional Home Care Programme, SAMOT, Palermo, Italia.
Drugs. 2021 Mar;81(4):411-418. doi: 10.1007/s40265-021-01466-5. Epub 2021 Jan 30.
Breakthrough cancer pain (BTcP) is a variegated phenomenon, that often presents in different ways in each individual, and may change its presentation in the same individual during the course of disease. An appropriate assessment is fundamental for depicting the pattern of BTcP in individuals. This information is determinant for a personalised management of BTcP. The use of opioids as needed, is recommended for the management of BTcP. There are several options which should be chosen according to the individual pattern of BTcP. In general, a drug with a short onset and offset should be preferred. Although oral opioids may still have specific indications, fentanyl products have been found to be more rapid and effective, providing analgesia in 5-15 min. The most controversial point regards the opioid dose to be used. The presence of tolerance suggests using a dose that is proportional to the dose used for background analgesia. In contrast, regulatory studies have suggested using the minimal available dose to be titrated until the effective dose. Further large studies should definitely settle this never-ending question.
爆发性癌痛（BTcP）是一种多变的现象，在个体中常常表现出不同的方式，并且在疾病过程中可能会改变其表现。适当的评估对于描绘个体中 BTcP 的模式至关重要。这些信息对于 BTcP 的个体化管理是决定性的。建议按需使用阿片类药物来治疗 BTcP。根据 BTcP 的个体模式，应选择几种方案。通常，应优先选择起效和失效时间较短的药物。虽然口服阿片类药物仍可能有特定的适应证，但芬太尼类产品已被证明更为迅速和有效，可在 5-15 分钟内提供镇痛作用。最具争议的问题是使用的阿片类药物剂量。存在耐受表明应使用与背景镇痛所用剂量成比例的剂量。相比之下，监管研究表明，应使用最小可用剂量滴定至有效剂量。进一步的大型研究肯定会解决这个无休止的问题。
