The prevalence of episodic pain in cancer: a survey of hospice patients on admission

Abstract

Pain that varies with time, referred to here as episodic pain, is a commonly encountered but under-investigated clinical problem. Previous studies of cancer patients have found that a significant proportion of their pains are episodic. To establish the prevalence and characteristics of episodic pains in hospice in-patients we assessed 245 consecutive admissions to four hospices in Yorkshire. The admitting doctor completed a questionnaire, detailing the characteristics of all pains experienced by the patient in the previous 24 h. Two hundred and forty-two questionnaires were entered into the study. One hundred and thirty-two patients reported pain in the preceding 24 h, of these 93% had at least one episodic pain. In total, 228 pains were described, of which 211 were episodic with a wide variation in their temporal characteristics, intensities and limitation. One hundred and fifty-two episodic pains had a precipitating factor; movement and weight bearing being the most frequent precipitants. One hundred and sixty-eight episodic pains had a relieving factor, medication improving 54%. Ninety-five pains were related to the malignancy and 47 to concurrent illness. The study confirms that episodic pain is extremely common in cancer patients referred for in-patient hospice care and highlights the need for further evaluation of its management.

Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

“…In some studies, peaks of pain intensity have been reported independently on the analgesic treatment, and in others no clear distinction between background and BTcP pain intensity has been reported [10][11][12][13][14]16,17 . We have previously shown that many studies of BTcP have been performed in patients with uncontrolled background pain.…”

“…despite relatively stable and adequately controlled baseline pain'' 4,7,8 . Other authors have proposed that BTcP is a transient exacerbation of pain that occurs irrespective of basal analgesia 9 , episodes of pain occurring on an unrealistic pain-free background 10 , or ''any transient flare of pain subjectively distinguishable from an otherwise more or less stable background pain'' 11 . In some cases there was no operational definition a priori, with incident pain due to movement given as an example, even though patients could have their pain uncontrolled or were not receiving opioids 12 .…”

Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group

“…Subsequently, other definitions were proposed, such as Ba transient exacerbation of pain that occurs irrespective of basal analgesia^ [13], Bepisodes of pain occurring on an unrealistic pain-free background^ [14], or Bany transient flare of pain subjectively distinguishable from an otherwise more or less stable background pain^ [15].…”

Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen

“…In der palliativmedizinischen Literatur werden Prävalenzen des Durchbruchschmerzes zwischen 23 [5] und 93% [23] aller Tumorpatienten berichtet, wobei sich im Durchschnitt der bisher publizierten Ergebnisse Anteile von ca. 60-70% schätzen lassen.…”