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Pain and Chemical Dependency News
Breakthrough pain is a transient increase in pain intensity over background
pain. It is a common in patients with cancer pain and can have a negative impact
in the quality of life for both patients and caregivers. Breakthrough pain is
usually related to background pain and is typically of rapid onset, severe in
intensity, and generally lasts for an average of 30 minutes. At present, the
current approach to managing breakthrough pain is using rescue medication proportional
to the total around-the-clock (ATC) opioid dose.
This review explores and assesses the evidence for using opioids to control
breakthrough pain in patients with cancer. The investigators searched several
medical and nursing databases in addition to medical journals and key textbooks.
Drug companies were also contacted for unpublished data. They selected randomized
controlled trials of opioids used as rescue medication in patients with cancer
pain. They looked at reduction in pain intensity, adverse effects, attrition,
patient satisfaction, and quality of life. Four studies (393 participants) met their inclusion criteria,
all were concerned with the use of oral transmucosal fentanyl citrate (OTFC)
in the management of breakthrough pain. Two studies examined the titration of
OTFC, one study compared OTFC to normal-release morphine, and one study compared
OTFC to placebo. OTFC was shown to be an effective treatment for breakthrough
pain. When compared to placebo and morphine, participants gave lower pain intensity
scores and higher pain relief scores for OTFC at all time points. Global assessment
scores also favored OTFC. The investigators conclude that OTFC is an effective
treatment in managing breakthrough pain, but more trials are needed. Zeppetella
G, Ribeiro M. Adapted from Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004311.
Read more: PMID 16437482
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the
National Library of Medicine (NLM).
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