Breakthrough cancer pain: ten commandments

6 from January to 2017

The term "breakthrough cancer pain" (BTcP) was introduced makes a 25 years old. During these years the study and analysis of this type of pain has improved our knowledge about the characteristics and treatment of this symptom.

The objective of this review of Dr Mercadante, is to provide the 10 fundamental concepts for a correct diagnosis and treatment, that can help the clinician to recognize and treat this type of pain.

1.-Assessment of analgesia basal.

2.-Drugs used in basal analgesia.

3.-Think of breakthrough pain as possible symptom.

4.-Characteristics of pain.

5.-Diagnosis of breakthrough pain,

6.-Specific assessment of breakthrough pain in patients.

7.-Definition of drug treatment in the patient,

8.-Opioid decide that quick release, It is best suited to the patient's analgesic needs.

9.-Opioid dosage,

10.- Patient education and caregivers.

Dolor irruptivo oncológico en el anciano

5 from January to 2017
“En este artículo titulado “Dolor irruptivo en el anciano” se hace una revisión general de diferentes aspectos del dolor irruptivo como la epidemiología, sus características, tipología, su valoración, manejo y tratamiento. Dentro de cada apartado se resaltan los datos conocidos y aplicables en el diagnóstico y tratamiento del dolor irruptivo en el anciano.

Los datos que se comentan no difieren excesivamente de los de la población no anciana ya que no existen apenas estudios específicos sobre el dolor irruptivo en ancianos y para el manejo del dolor irruptivo y de otros muchos aspectos, al menos en oncología, en esta población, se realizan extrapolaciones de estudios realizados en población más joven,…. lo que dificulta aún más la caracterización de esta entidad en la población geriátrica y su tratamiento, siendo el manejo en esta población, prácticamente empírico.

Otro aspecto importante es that, al igual que ocurre en otras patologías en el paciente anciano, la presentación atípica del dolor, la presencia de deterioro cognitivo y de otras condiciones que pueden dificultar su valoración contribuyen a un mayor riesgo del de infradiagnostico del dolor irruptivo en esta población. A la empiricidad se suma el infradiagnóstico.

Por lo anterior se hace evidente la necesidad de realizar estudios, ensayos clínicos, focalizados en este grupo población en concreto, que supondrá más del 30% de la población occidental en escasamente 15 years old.

Os invito a leer este artículo donde se repasan aspectos del dolor irruptivo ya comentados en artículos previos publicados en la página y aborda los aspectos conocidos y lo conocido en ello del dolor irruptivo en ancianos.”

Rotation of opioids

17 in December of 2016

La rotación de opioides es un término dado a la práctica clínica al sustituir un opioide de tercer escalón de la O.M.S por otro cuando no se consigue un equilibrio satisfactorio entre el alivio del dolor y los efectos adversos a pesar de una titulación apropiada del primer opioide y se suele usar en casos de dolor refractario. Rotation of opioids (ROP).

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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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