Breakthrough Cancer Pain in Patients Receiving Low Doses of Opioids for Background Pain. (20th December 2019)

• Record Type: Journal Article
• Authors: Mercadante, Sebastiano; Caraceni, Augusto; Masedu, Francesco; Scipioni, Teresa; Aielli, Federica
• Is Part Of: Oncologist. Volume 25:Number 2(2020)
• Page Start: 156
• Page End: 160
• Publication Date: 2019-12-20
• Subjects: Breakthrough cancer pain -- Opioids -- Doses; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2019-0542
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: Background: This study aimed to assess the characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain in comparison with patients receiving at least 60 mg of oral morphine equivalents (OME). Materials and Methods: Patients with advanced cancer receiving less than 60 mg/day of OME with episodes of BTcP were included in the analysis (group L). Data were compared with patients receiving doses of opioids ≥60 mg of OME (group H). Pain intensity, current analgesic therapy, number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, and time to meaningful pain relief were collected. Adverse effects imputable to a BTcP medication were recorded. Results: A total of 1, 418 and 2, 474 patients were included in groups L and H, respectively. A lower number of BTcP episodes ( p = .005), a lower BTcP intensity ( p = .0001), a faster BTcP onset ( p = .024), and a longer time to meaningful pain relief after taking a BTcP medication ( p = .009) were found in group L as compared with group H. In group L, BTcP interference on daily activity was less than in group H ( p = .009). Patients in group L were less likely to be prescribed an opioid as BTcP medication in comparison with patients in group H ( p = .0001). Opioid doses used for BTcP were significantly higher in group H. Patients in group L were more likely to be less satisfied ( p = .003) than patients in group H. No adverse effects of severe intensity were reported in both groups. Conclusion: Patients receiving lower doses of opioids exhibit some differences in BTcP presentation: fewer episodes with lower intensity and a faster onset, a longer time to meaningful pain relief, and less satisfaction with BTcP medication. A relevant percentage of patients was receiving fentanyl preparations normally reserved for patients receiving higher doses of opioids. Implications for Practice: Breakthrough pain is present in patients receiving low doses of opioids. It has its own peculiarities: less frequent, lower intensity, faster onset, longer time to meaningful pain relief, and less satisfaction with medication. Many patients were prescribed fentanyl preparations, which are normally reserved for patients receiving higher doses of opioids. Abstract : Breakthrough cancer pain has been defined as a peak of pain intensity of short duration in patients with stable analgesia provided by round‐the‐clock analgesics. This study assessed the characteristics of breakthrough cancer pain in patients receiving less than 60 mg/day of oral morphine equivalents for their background pain, compared to those observed in patients receiving higher doses.