Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso

Abstract

Introduction objectives: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved in its management have different diagnostic and therapeutic criteria.In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document.Methods: After an initial search on the most relevant publications in BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan® methodology -a structured brainstorming technique-that produced a first version of the Consensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish Intercollegiate Guidelines Network) system.Outcomes: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary.The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain.Conclusion: This Consensus can be a very useful tool to improve the quality of life in cancer patients, because it guides the clinician towards a better diagnose and treatment of BTcP.

Consensus statement on the management of breakthrough cancer pain: Assessment, treatment and monitoring recommendations

“…Breakthrough cancer pain was fi rst defi ned by Portenoy et al in 1990 [7], as 'a transitory exacerbation of pain experienced by patients undergoing long-term opioid treatment for cancerrelated pain whose baseline pain is adequately controlled', but there has been controversy with respect to this defi nition over the past two decades. Some international guidelines recommend the defi nition of BTcP derived from the original by Portenoy [9][10][11][12], whereas others have established their own defi nition [13][14][15]. The main discrepancy is the fact that BTcP can also occur in the absence of background cancer pain and regardless of opioid treatment [16,17].…”

“…In 2012, an association of Spanish medical doctors, composed of palliative care, pain specialists, oncologists and radiation oncology experts, produced a consensus document with a series of guidelines to properly diagnose and treat BTcP patients. BTcP at that time was defi ned as 'a transient, highly intense exacerbation of pain of short duration (less than 20-30 minutes) appearing through a stable pain baseline that can be controlled by opioid treatment' [13]. Although this defi nition is still valid, some clarifi cations are needed.…”

Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain (Preprint)

“…Testing the usability of these tools revealed that definitions of Davies [6] and Escobar et al [17] along with the Davies algorithm were the most used. One of the difficulties attributed to assess the prevalence of BTcP in the cancer population lies in the variety of definitions that exist and are used for BTcP.…”

“…After testing the different level of usage of this diagnostic workflow, BTcP definition by Davies et al [6] and Escobar et al [17] along with the Davies algorithm were shown to be mostly used (Fig. 3).…”

“…The workflow of a new register was summarized in Figure 2. Briefly, after reading two different definitions of BTcP (Davies et al [6] and Escobar et al [17]; Fig. 1c), some more information related to the Davies diagnosis algorithm of BTcP (frequency and control of baseline pain, and the occurrence of transient pain episodes) is introduced (Fig.…”