Inter and intra-patient variability in breakthrough pain episodes of opioid-treated patients with underlying chronic pain

17 in October of 2016



Soc Rev Esp Pain. 2016; 23(1): 6-15

This article published in 2016, I find it very interesting in terms of the assessment of breakthrough pain (A) in 50 patients: 23 oncological and 27 chronic benign pain observing the great interindividual variability as both intrapatient exists as to the characteristics of the DI: type of pain, intensity and duration of each episode; situation that often see in our daily clinical practice.

Starting from the premise that pain is a symptom and changing and evolving, that is why, treatment should be dynamic, I seem very successful using a journal where the patient and their family environment,es, can actively participate; since for the successful treatment of DI it is essential to good health education to improve compliance and minimize potential adverse effects.

Selección y comentarios: Pull. Immaculate Farrier Montiel


What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-39-00What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion

Working Group Nientemale OF, R. Vellucci, G. Fanelli, R. Pannuti, C. Peruselli, S. Adamo, G. Alongi, F. Amato, The. Consoletti, The. Lamarca, S. Liguori, C. Lo Presti, A. Maione, S. Mameli, F. Marinangeli, S. Marulli, In. Minotti, D. Miotti, The. Montanari, G. Moruzzi, S. Palermo, M. Parolini, P. Poli, In. Tirelli, A. Valle, and P. Romualdi

Trabajo muy interesante con alto contenido docente para el reconocimiento del DIO y su tratamiento. El trabajo realiza una revisión sobre el DIO y su tratamiento y aporta unas recomendaciones respecto a qué hacer / y no hacer en el tratamiento del DIO. Ha sido escrito por un grupo de expertos italianos en dolor. El trabajo ha recibido alguna crítica que es adecuadamente contestada por los autores. Altamente recomendable su lectura así como la réplica de los autores a la crítica recibida (ésta también está disponible en esta web)

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Reply-Letter to the Editor: What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain: Expert Opinion

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-13-17Reply-Letter to the Editor: What to Do, and What Not to Do, When Diagnosing and Treating BreakthroughCancer Pain (BTcP): Expert Opinion.

pdfWorking Group Nientemale OF, Vellucci R, Fanelli G, Cortesi PA, pans R, Peruselli C, Romualdi P

Drugs. 2016 Jul;76(10):1063-5. two: 10.1007/s40265-016-0594-z

It is a replica of the authors to criticism by a previously published work. In this case, the reply goes beyond a discussion or justification of what is published, It includes an important reflection on the Infra-cancer pain and DIO and criticism of the use of fentanyls quick action by high costs,es.

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Breakthrough cancer pain: twenty five years of study

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-00-31Breakthrough cancer pain: twenty-five years of study.

Merchant S, Portenoy RK.

Pain. 2016 Sep 19. [Epub ahead of print]

Interesting work of opinion on the DIO by two of the authors who have published more about it or were initiated by the identification of these crises painful. The paper describes the beginnings of the characterization of the DIO, the changes that have occurred in their conception and resolve outstanding issues. Recommended reading

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Presentation Scientific Committee

4 in October of 2016

dr-benitezDr. Miguel Angel Benitez Rosario

Specialist Palliative Care

Hospital Universitario Ntra. Sra. La Candelaria, Tenerife

Curriculum summarized

dra-herradorPull. Immaculate Farrier Montiel

Specialist in Anesthesiology, Resuscitation and Pain Therapy

Hospital Universitario Reina Sofia, Cordova

Curriculum summarized

dra-morillaPull. Idoia Morilla Ruíz

Specialist Radiation Oncology and Medical Oncology

Catalan Institute of Oncology, Hospital Duran i Reynalds, Barcelona

Curriculum summarized

Cover Letter Scientific Committee

Dear partners

In recent years, we have made progress in understanding, clinical diagnosis and treatment of this type of severe pain is known as breakthrough pain that occurs in a high percentage of our cancer patients, increasing by increased survival rates of many cancers.


Breakthrough cancer pain: visión rápida

12 in September of 2016


Breakthrough pain is seen as a crisis of rapid onset and short duration of pain that occurs in a patient whose baseline pain is adequately controlled or mild.

Breakthrough pain is considered a different pain syndrome, independent, baseline pain. It does not correspond to episodes of different baseline pain intensity of uncontrolled.
The duration of these pain crises is variable, from few minutes to 1 time, but more often are less episodes 45 minutes. The intensity is usually moderate to severe since the onset of the crisis pain. The number of episodes of pain varies between patients, from rare to frequent.

The concept of breakthrough pain includes three types of pain:

  • which it appears after a triggering element (for example an unusual effort), and it is categorized as incidental pain,
  • which it appears without apparent cause, I considered as idiopathic or spontaneous pain or actual breakthrough,
  • el asociado a actividades diagnósticas médicas y/o curas de enfermería, conocido como dolor procedimental

En cualquier caso ha de considerarse que la presencia de un dolor irruptivo se corresponde con un incremento de los estímulos álgicos y no con un fallo de la eficacia del tratamiento analgésico basal.


Actualizaciones en dolor irruptor

7 in September of 2016
Captura de pantalla 2016-09-07 a las 11.12.22

The term breakthrough pain (Dolor Irruptivo-DI) It is defined for the first time in 1990 by Portenoy and Fine, as: "Transitory exacerbation of pain that occurs in a context of stable baseline pain in a patient treated with opioids chronically".

For diagnosis a number of requirements are established:

1.-Existence of a stable analgesia during 48 previous hours

2.-Existence of controlled baseline pain during 24 previous hours

3.-Presence of temporary exacerbations of intense or stabbing pain during 24 previous hours

Captura de pantalla 2016-09-07 a las 11.05.47Hoy en día se distinguen tres tipos:

1.-dolor incidental predecible (asociado al movimiento, activity, intake, cleanliness, asociado a pruebas diagnósticas y curas de enfermería, etc..)

2.-dolor incidental impredecible (distention associated with hollow viscera, cough, bladder spasms, isquemia, etc.)

3.-dolor irruptivo espontáneo (independiente del estímulo)


Canadian recommendations for the management of breakthrough cancer pain

3 May of 2016
Captura de pantalla 2016-05-03 a las 16.04.13

“In this full article, a group of Canadian specialists in Palliative Care, Oncology t Anesthesia, establish a code of practice for the management of breakthrough pain in cancer patients. They addressed practically all aspects of this type of pain, and at every point consensus recommendations are established and “educational points” facilitating the diagnosis and therapeutic management of breakthrough pain. Article of great interest to specialists involved in the care of this group of patients.”

Selección y comentarios: Dr. Luis Olay