Relieving Breakthrough Cancer Pain
Reported September 14, 2009
(Ivanhoe Newswire) — A recent European survey of Breakthrough Cancer Pain (BTCP), the first to look the phenomenon from a patients perspective, offers valuable insight into cancer patients’ experiences with breakthrough pain management and the impact of the condition on their daily lives.
BTCP is a brief flare-up of severe pain that occurs even while the patient is regularly taking medication for chronic pain. It comes on quickly and may last from a few minutes to an hour. Many patients experience a number of episodes of breakthrough pain each day.
BTCP can result either from the cancer or from the cancer treatment, or it may occur during a certain activity, such as walking, dressing or coughing. It also can occur unexpectedly, without a preceding incident or clear cause.
Early results for patients from the UK, Sweden and Denmark offered the following insights:
On average each patient had three episodes of BTCP per day.
Each episode had an average duration of 60 minutes.
Ninety-six percent of the pain episodes were described as moderate to severe.
Eighty-seven percent of patients reported their BTCP interfered with their daily living including their ability to sleep, walk and get on with other people.
“The study documents that breakthrough pain has a significant impact on cancer patients’ daily lives,” Dr. Andrew Davies, Department of Palliative Medicine, Royal Marsden Hospital, UK and the principal investigator of this survey was quoted as saying. “Breakthrough pain is very different to background pain. Background pain is a continuous, chronic pain requiring around-the-clock medication. Breakthrough pain is a fast onset, short duration, intense pain that breaks through the chronic pain even when this is being controlled with medication. It is incapacitating and very distressing to the patient.”
For this kind of pain episode, the ideal treatment is fast acting, with short duration, to most closely match the nature of BTCP episodes. Moreover, it must be easy to use to ensure patient compliance.
Survey results, however, showed 98 percent of patients were using orally administered drugs. The time to first noticing a reduction in pain was, on average, 20 minutes. The time to knowing that the pain medication was really making a difference was, on average, 30 minutes, or half way through the typical BTCP episode observed in this survey.
“Oral opioids are still commonly used to manage BTCP, despite the fact that the way these drugs work does not match the characteristics of a BTCP episode, said Dr. Davies. Opioids given by other routes, for example intranasal, have significant advantages over oral opioids and the interim results from this survey suggest that these routes would be suitable for and welcomed by the majority of cancer patients with breakthrough pain.”
SOURCE: Presented at the Congress of the European Federation of Chapters of the International Association for the Study of Pain (EFIC), September 11, 2009
