Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients

Abstract

Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics.

Assessment of symptoms, quality of life and associated costs in a one-month follow-up of cancer patients with breakthrough pain: The IMDI Study

“…BTP was defi ned in 1990 by Portenoy, et al, as a "transient exacerbation of pain that occurs either spontaneously, or in relation to a specifi c predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain" [4]. The intensity of BTP is severe and of short duration, usually lasting fewer than 60 minutes and appearing 3-5 times a day [1,5,6].…”

Factors influencing the use of opioids for breakthrough cancer pain: A secondary analysis of the IOPS‐MS study

“…BTcP interferes with quality of life and is associated with a relevant morbidity (Portenoy et al, ). Cancer patients experience daily peaks of pain intensity with different characteristics in terms of predictability, onset and duration (Davies et al, ; Narayana et al, ; Mercadante et al, ). Considering the temporal pattern of BTcP, characterized by a short onset and duration, opioids providing a rapid analgesia are commonly given as needed in addition to the background analgesic medication to manage these episodes.…”

“…Recently, a study with a large number of patients with BTcP has been concluded. Data revealed that BTcP is a multifaceted phenomenon that is present at any stage of cancer disease and that its clinical presentation depends on many inter‐related factors (Mercadante et al, ). This study assessed, by a secondary analysis of data gathered from a large national study, the factors influencing the use and the doses of opioids prescribed for BTcP, the level of patients’ satisfaction with BTcP medications and adverse effects, and especially whether the doses opioids used for BTcP were proportional to the basal opioid regimen in routinary clinical practice.…”

Dor como queixa inicial do câncer de boca e orofaringe: caracterização de amostra

“…dos pacientes com câncer procuraram esse profissional, que foi em parte responsável pelo diagnóstico final, mas provavelmente não todos. A literatura mostra que dor de dente, mobilidade de dente e sangramento localizado podem ser as queixas iniciais dos pacientes com câncer de boca (Cousin, 1994;Cuffari et al, 2006;Scully, Bagan 2009 (Cuffari et al, 2006), indicar a transformação de lesão nãomaligna em maligna , Schmidt, 2015, indicar a recidiva do câncer (Reyes-Gibby et al, 2014) e também ser indicador de sobrevivência do paciente (Teng et al, 2013;Reyes-Gibby et al, 2014 Hagen, 1990;Portenoy et al,1999;Bhatnagar et al, 2010;Mercadante et al, 2018). (Connelly, Schmidt, 2004;Pimentel, 2004;Benoliel et al, 2007).…”

“…A dor foi relatada por 96% como dor contínua; 75% relataram dor relacionada ao tumor; 20% ao tratamento e 5% a outras causas. A duração foi maior do que 30 minutos Mercadante et al (2018). analisaram 4016 pacientes; 5,1% dos pacientes apresentavam câncer na região de cabeça e pescoço; as características da BP foram as seguintes: 2,4 episódios em média por dia, dor de intensidade 7,5 e duração de 43,3 minutos.…”