|R. Portenoy, MD, Memorial Sloan Kettering Cancer Center (MSKCC), New York City, presented data from three surveys on breakthrough pain (BTP). On average, 64.9% or 863/1329 surveyed cancer patients reported BTP. One method for relieving BTP, based on clinical experience, calls for giving an immediate-release opioid analgesic at 5%-15% of the total daily dose.|
|Surveys at MSKCC||
The first study evaluated 63 patients. Sixty-four per cent
(40/63) of this group reported BTP (Pain, 41, 1990; 273-281).
The second MSKCC survey of 166 cancer patients found 52% positive for BTP. On average, patients reported 5.8 pains/24 hours with a range of 1-60. Precipitants of BTP were variable, including 13% due to end-of-dose failure and 38% unsure. Portenoy finds BTP often signifies a relatively more severe pain syndrome.
|International Twenty-three Country Survey||Preliminary results show 67% of 1100 cancer patients experience BTP. Within the sample, pain was severe in 70% and tumor-induced in 94%. Additional tabulations of data are in progress.|
BTP, as defined by Portenoy, is a transient severe or excruciating flare of pain that occurs on a
backround of moderate or mild
pain. Clinical experience rather than scientific evidence often
guides the clinician in treating BTP. Perhaps one formulation of
an opioid (e.g. a long acting drug) for baseline treatment and
another opioid formulation (e.g. a short acting drug) for BTP
C. Wright, MD, Food & Drug Administration, Rockville, MD, asked "Does giving a larger dose of the base opioid provide better pain control than using a lower chronic dose supplemented for BTP?" This query flows from the observation (unpublished) that at least 50% of cancer patients prefer the second option.
For professional correspondence, please contact Dr. Portenoy at: firstname.lastname@example.org
Presented at American Pain Society Meeting on 15 Nov 1996
CONRAD NOTES, © November 1996 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 26-Dec-1996