Current management of breakthrough cancer pain according to physicians from pain units in Spain

Estévez, Francisco; Alarcón, María Dolores López; Mayoral, V.; Madariaga, María de; Margarit, César; Durán, J. Arranz; Martín-Arroyo, José Manuel Trinidad; Carregal, A

doi:10.1007/s12094-019-02044-8

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…Like in a recent national report [ 33 ], just over half the respondents participated in teaching and research activities, but the estimated proportion of sites that could be regarded as multidisciplinary (over 53.5%) was slightly higher than nationwide [ 34 ]. Although the lower confidence limit of 41.3% is not above the national figure, the actual proportion is probably higher because multidisciplinarity does not necessarily entail teaching and researching [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 92%

“…Thus, even realizing that Catalonia has more pain facilities than the rest of Spain [ 52 ], nonresponders would probably work in less structured and equipped facilities than responders, who in some instances would also have regarded any organized specialized pain practice as a pain center or clinic. Nonetheless, even if only 50–66% of the surveyed sites were truly multidisciplinary (see above), access to such care would be approximately one per 174,000–228,000 people, in line with or above other countries [ 23 ] and Spain as a whole [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician’s Survey

Medel

Serrano

Batet

et al. 2022

Pain Research and Management

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Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician’s Survey

Medel

Serrano

Batet

et al. 2022

Pain Research and Management

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“…This suggests that educational activities may be helpful in improving the implementation of current guidelines. Other recent surveys of pain specialists in Spain showed that ROOs are still underused (53,54).…”

Section: The Role Of Physician's Educationmentioning

confidence: 99%

Rapid-Onset Opioids for Management of Breakthrough Cancer Pain: Considerations for Daily Practice

2022

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Background and ObjectiveRapid-onset opioids (ROOs) are effective treatments for breakthrough cancer pain (BTcP) given their rapid onset of action and relatively short duration of analgesia. The aim of this article is to describe specific considerations for the use of ROOs in daily practice, focusing on dose titration and treatment of specific populations.Type of ReviewWe conducted a narrative review on the use of ROOs for BTcP. We selected papers according to the following search terms: “breakthrough cancer pain” and “rapid onset opioids”.ResultsROOs may be considered as the most suitable drugs to treat BTcP and can be used “on-demand”. Several fentanyl formulations are available and have been associated with control of BTcP and with improvement in quality of life. Various titration schemes have been used to optimize ROO dosing; however, a dose-proportional scheme could be considered safe and effective in most patients. Specific formulations may be more suitable for specific patient subgroups; for example, patients with oral mucositis may prefer intranasal to oral formulations. Moreover, elderly patients or those without caregivers should be clearly educated on the use of these formulations. A key element in achieving successful treatment of BTcP is awareness of the barriers to pain management, including poor overall assessment, patient reluctance to take opioids or report pain, and physician reluctance to prescribe opioids.ConclusionA personalized approach is fundamental when prescribing a medication for BTcP, and careful attention should be given to drug choice and route of administration, and to the need for alternative therapeutic options.

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Breakthrough cancer pain treatment in Spain: physicians’ perception of current opioids utilization and prescription

Estévez

Alarcón

Babarro

et al. 2020

Current Medical Research and Opinion

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Current management of breakthrough cancer pain according to physicians from pain units in Spain

Cited by 7 publications

References 31 publications

Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician’s Survey

Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician’s Survey

Rapid-Onset Opioids for Management of Breakthrough Cancer Pain: Considerations for Daily Practice

Breakthrough cancer pain treatment in Spain: physicians’ perception of current opioids utilization and prescription

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