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Breakthrough cancer pain – still a challenge

Authors Margarit C, Juliá J, López R, Antón A, Escobar Y, Casas A, Cruz JJ, Gálvez R, Mañas A, Zaragozá F

Received 27 July 2012

Accepted for publication 24 September 2012

Published 19 November 2012 Volume 2012:5 Pages 559—566


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Cesar Margarit,1 Joaquim Juliá,2 Rafael López,3 Antonio Anton,4 Yolanda Escobar,5 Ana Casas,6 Juan Jesús Cruz,7 Rafael Galvez,8 Ana Mañas,9 Francisco Zaragozá10

1Pain Unit, Alicante University General Hospital, Alicante, Spain; 2Department of Integral Support-Palliative Care, Catalan Institute of Oncology (ICO), Germans Trias i Pujol University Hospital, Badalona, Spain; 3Department of Clinical Oncology, University Hospital Complex, Santiago de Compostela, Spain; 4Department of Clinical Oncology, Miguel Servet Hospital, Zaragoza, Spain; 5Department of Clinical Oncology, Gregorio Marañón Hospital, Madrid, Spain; 6Department of Oncology, Virgen Macarena Hospital, Seville, Spain; 7Department of Clinical Oncology, Salamanca Hospital, Salamanca, Spain; 8Pain and Palliative Care Unit, Virgen de las Nieves Hospital, Granada, Spain; 9Department of Oncology–Radiotherapy, La Paz Hospital, Madrid, Spain; 10Department of Pharmacology, University of Alcalá de Henares, Spain

Abstract: Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%). According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing – affording rapid and effective analgesia with the added advantage of being easily administered by caregivers when patients are unable to collaborate.

Keywords: prevalence, management, diagnosis, opioids

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