Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso

Abstract

Introduction and 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. Results: 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.

Breakthrough cancer pain (BTcP) management: a review of international and national guidelines

“…The search revealed a number of generic cancer pain guidelines that included recommendations about the management of BTcP, but relatively few specific BTcP guidelines; the latter included one Canadian,14 one German,15 two Italian,16 17 one Spanish,18 the European Oncology Nursing Society guidelines11 12 and an international pharmaceutical company-sponsored review of BTcP guidelines 19. The search also revealed French guidelines that discuss the use of the so-called rapid-onset opioids (ROOs) for BTcP, rather than the general management of BTcP 20 21.…”

“…The Spanish guidelines include the necessity of the receipt of opioids to make a diagnosis of BTcP 18. Nevertheless, the aforementioned Spanish Delphi clinician surveys did not find good consensus regarding the latter criterion 30 32.…”