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

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• 作者：Erik Torbj&oslash ; rn L&oslash ; hre ; MD^a ; ^c ; ^{erik.t.lohre@ntnu.no" class="auth_mail" title="E-mail the corresponding author} ; På ; l Klepstad ; MD ; PhD^b ; ^d ; Michael I. Bennett ; MB ; ChB ; MD (Hons) ; FRCP ; FFPMRCA^e ; Cinzia Brunelli ; ScD^a ; ^f ; Augusto Caraceni ; MD^a ; ^f ; Robin L. Fainsinger ; MD^g ; Anne Kari Knudsen ; MD ; PhD^a ; ^c ; Sebastiano Mercadante ; MD^h ; Per Sj&oslash ; gren ; MDⁱ ; Stein Kaasa ; MD ; PhD^a ; ^c ; for the European Association for Palliative Care Research Network
• 关键词：Cancer pain ; pain classification ; pain assessment ; breakthrough pain ; episodic pain ; Delphi study
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：51
• 期：6
• 页码：1013-1019
• 全文大小：313 K

文摘

Cancer pain can appear with spikes of higher intensity. Breakthrough cancer pain (BTCP) is the most common term for the transient exacerbations of pain, but the ability of the nomenclature to capture relevant pain variations and give treatment guidance is questionable.

Objectives

To reach consensus on definitions, terminology, and subclassification of transient cancer pain exacerbations.

Methods

The most frequent authors on BTCP literature were identified using the same search strategy as in a systematic review and invited to participate in a two-round Delphi survey. Topics with a low degree of consensus on BTCP classification were refined into 20 statements. The participants rated their degree of agreement with the statements on a numeric rating scale (0–10). Consensus was defined as a median numeric rating scale score of ≥7 and an interquartile range of ≤3.

Results

Fifty-two authors had published three or more articles on BTCP over the past 10 years. Twenty-seven responded in the first round and 24 in the second round. Consensus was reached for 13 of 20 statements. Transient cancer pain exacerbations can occur without background pain, when background pain is uncontrolled, and regardless of opioid treatment. There exist cancer pain exacerbations other than BTCP, and the phenomenon could be named “episodic pain.” Patient-reported treatment satisfaction is important with respect to assessment. Subclassification according to pain pathophysiology can provide treatment guidance.

Conclusion

Significant transient cancer pain exacerbations include more than just BTCP. Patient input and pain classification are important factors for tailoring treatment.