Characteristics of breakthrough cancer pain and its influence on quality of life

9 in December of 2016

Research work carried out by the research group of the European Society for Palliative Care. Its aim was to determine the prevalence of breakthrough pain in patients with advanced cancer. The study was conducted in 17 palliative care units 8 European countries. A cross sectional study in which he spent several questionnaires was conducted (Brief Pain Inventory, Alberta Breakthrorugh Pain Assessment Tool – ABPAT- and quality of life questionnaire QLQ-C30 EORT) to the patients, they answered the questionnaires on a computer.

a convenience sample of analyzed 978 patients, average age of 62 years old, 48% women and 85% They had a situation of metastatic disease. Of these, the 30% had no pain. Of the 682 pain patients, the 30% described situations of painful crises, which reached its maximum intensity in less painful 10 minutes. Patients with more severe baseline pain described greater number of painful crises and more intense. The presence of breakthrough pain was significantly associated with poorer quality of life.

Comment. A new epidemiological study confirms the high prevalence of breakthrough pain in patients with advanced cancer. The presence of breakthrough pain involves a significant alteration of the quality of life. The significance of the data rests, among other things, in the number of patients observed and which come from a multicenter study 8 countries. This counteracts possible interference of cultural aspects regarding pain and its treatment results,es.

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

2 in December of 2016

advances-in-therapycaptura-de-pantalla-2016-12-02-a-las-11-57-29Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS) mano

Sebastiano Mercadante . Paolo Marchetti . Arturo Cuomo . Augusto Caraceni . Rocco Domenico Mediati . Massimo Mammucari . Silvia Natoli . Marzia Lazzari . Mario Dauri . Mario Airoldi . Giuseppe Azzarello . Mauro Bandera . Livio Blasi . Giacomo Carten`ı . Bruno Chiurazzi .Benedetta Veruska Pierpaola Costanzo . Daniela Degiovanni . Flavio Fusco . Vittorio Guardamagna . Vincenzo Iaffaioli . Simeone Liguori . Vito Lorusso . Sergio Mameli . Rodolfo Mattioli . Teresita Mazzei . Rita Maria Melotti . Valentino Menardo . Danilo Miotti . Stefano Moroso . Stefano De Santis . Remo Orsetti . Alfonso Papa . Sergio Ricci . Alessandro Fabrizio Sabato . Elvira Scelzi . Michele Sofia . Giuseppe Tonini . Federica Aielli . Alessandro Valle . On behalf of the IOPS MS study group.

Selección y comentarios: Pull. Idoia Morilla

“Se trata de un estudio observacional (descriptivo) multicéntrico italiano de 1500 pacientes dirigido por el Dr Mercadante, sobre el diagnostico, características del dolor y tratamiento del dolor irruptivo en pacientes con diferentes tipos de neoplasias en diferentes estadios”.

Addiction against pseudoaddiction

2 in December of 2016

medicinaq-paliativaAddiction against pseudoaddiction

M. Belen Gonzalez Gragera, Joan Santamaria semis, Raquel Rodriguez Quintana, Maria Iglesias González, Joaquim and Julia Torras

Medicina Paliativa. MEDIPAL 2015;22 Supl 1:20-6 mano

Selección y comentarios: Pull. Idoia Morilla

“En este artículo se analizan y concretan los distintos conceptos y comportamientos que deben hacer sospechar los diagnósticos de adicción y pseudoadicción, these factors associated, and therapeutic recommendations for safe and efficient prescription. To prevent the occurrence of addiction, seudoadicción y afrontamiento químico es necesario un abordaje multidisciplinar de cada una de sus dimensiones (physical, psychological, social and spiritual), especially in the management of anxiety and depression”

From “Breakthrough” to “Episodic” Cancer Pain?

1 in December of 2016
jpsm

Brunelli C, Caraceni A, Fainsinger RL, Knudsen, AK, Merchant S, Sjogren P, Includes S;

European Association for Palliative Care Research Network. From “Breakthrough” to “Episodic” Cancer Pain?

A European Association for Palliative Care Research Network Expert Delphi Survey Toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations. J Pain Symptom Manage. 2016 Jun;51(6):1013-9. two: 10.1016/

Selección y comentarios: Dr. Miguel Ángel Benítez

Work product of an investigation of one of the most productive groups of the European Society for Palliative Care. They conducted a study of international consensus through Delphy method. They included 50 professional experts who had published about cancer pain, with a response rate of approximately 50%. They asked about 20 issues in which the expressed level of agreement between 0 and 10. The results showed that there is no consensus about what is the breakthrough pain. So, It admits that breakthrough pain is an intense painful crisis that may be present in patients with baseline pain controlled or not (presence of mild to moderate pain), take opioids or, and regardless of the baseline pain intensity, there is also no consensus on what is the intensity of pain measured in. However, It seems clear, that although there may be different kinds of breakthrough pain it must be differentiated from baseline pain.

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Breakthrough pain and its treatment: critical review and recommendations of IOPS

24 in November of 2016

supportive-care-in-cancerMerchant S, Marchetti P, Cuomo A, Mammucari M, Caraceni A; IOPS MS study Group. Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group. Support Care Cancer. 2016;24(2):961-8. two: 10.1007/s00520-015-2951

critical review of the diagnosis and treatment of breakthrough pain by a group of Italian experts in pain.

The work reflects the difficulties in the acceptance of a universal definition and this affects the epidemiological data on the prevalence of breakthrough pain. In the definition of the concept of breakthrough pain crisis pain is always maintained but with discrepancy if absent on a baseline pain, un dolor basal leve o moderado y si el paciente debe estar en tratamiento con opioides.

Consideran que la presencia de 4 o más episodios de dolor intenso debe conducir a aumentar la analgesia basal. Defienden el uso de las formulaciones de liberación rápida de fentanilo para el tratamiento del dolor irruptivo. La selección de una formulación específica se realizará según las características de la mucosa oral y de la nasal; y de la comodidad del paciente o habilidad para el uso. Recomiendan realizar un seguimiento del paciente respecto al cumplimiento del tratamiento y si mal pdfcumplimento o insatisfacción con el producto cambiar de formulación.

Selección y comentarios: Dr. Miguel Ángel Benítez

Procedural Pain in Palliative Care: is it breakthrough pain?

12 in November of 2016
captura-de-pantalla-2016-11-12-a-las-19-33-24

Procedural Pain in Palliative Care: Is It Breakthrough Pain? A Multicenter National Prospective Study to Assess Prevalence, Intensity, and Treatment of Procedure-related Pain in Patients with Advanced Disease.

Clin J Pain. 2016 Oct 20.

“prospective multicenter study 23 palliative care units Italy. Its aim was epidemiologically assess the presence of breakthrough pain in routine care activities performed by health professionals. In this case, breakthrough pain called procedural pain. The procedures were evaluated postural changes, transfers from bed to chair or wheelchair, en polls vesicle, daily cleaning bath or bed, the healing of skin ulcers and subcutaneous administration of medication.

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XXV Congreso de la Asociación Andaluza del Dolor

31 in October of 2016
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Resumen elaborado por la Dra. Inmaculada Herrador

Hospital Universitario Reina Sofia, Cordova

Between days 27 and 29 de Octubre se celebró en Cádiz el XXV Congreso de la Asociación Andaluza de dolor y asistencia continuada. Ha sido muy enriquecedor compartir e intercambiar con mis compañeros la información que se ha tratado.

Referente a la mesa de DIO, se abordaron tres temas importante:

  • Actualización en DIO por Inmaculada Herrador Montiel (Anestesióloga)
  • Medical liability and patient treatment with opioids: marco jurídico y problemas prácticos por Ricardo Ruiz de la Serna (Licenciado en derecho)
  • Seguridad de los opioides por Sergio Maldonado Vega ( Anestesiólogo)

Desde el punto de vista legal, Ricardo Ruiz de la Serna hizo una exposición magnífica de la importancia que tiene el obtener el consentimiento informado por escrito cuando se prescriban opioides a nuestros pacientes por todas las implicaciones de responsabilidad civil médica que conlleva.

Referente a la mesa de Trending topics en dolor también se abordaron tres temas de relevancia:

  • Formación en dolor por Milagros Rivera Pérez
  • Latest posts in pharmacological treatment of chronic pain by Juan Caballero Callejas
  • Rotation of opioids (ROP)por Inmaculada Herrador Montiel

En cuanto a la ROP, que como todos sabemos se usa en caso de dolor refractario, después de hacer una revisión bibliográfica la conclusión fundamental es que las tablas de equivalencia de opioides deben usarse de forma orientativa ya que más que dosis equianalgésicas son una ratio de conversión inicial. La ROP por lo tanto, no es un mero cálculo matemático por toda la variabilidad individual que existe en la respuesta a los opioides y las propiedades farmacodinámicas y farmacocinéticas de los distintos compuestos químicos que existen en el mercado.

Reunión de expertos: breakthrough cancer pain

22 in October of 2016
captura-de-pantalla-2016-10-22-a-las-11-10-25

Alicante was made in a meeting of experts in the area to discuss various aspects ON cancer breakthrough pain.

The assistants, experts in the management of cancer breakthrough pain (DIO), They are corresponding to different specialties thus providing a multidisciplinary approach of this clinical situation present in Pain Units, Palliative units, Services of Medical Oncology and Radiation Oncology Services.

The discussion centered around a series of questions related to the approach of breakthrough cancer pain from the experience of each of the participants to reach consensus answers.

The questions raised are as follows:

  1. How do you choose between them fentanyls? Is there any preference according to the route of administration?
  2. Importance of attributes: Speed ​​of action according to the route of administration
  3. Importance of attributes: Metering accuracy and range of doses. Prescribed dose at the start
  4. Monitoring the evaluation of analgesic efficacy
  5. Importance of attributes: Comfort in the administration and enforcement in bedridden patients
  6. Importance of attributes: Ease of explanation and support materials
  7. Accessibility laboratory for consultations and questions. Product experience

pdfDesarrollo de las respuestas y documento final