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Conrad Notes
a timely medical meeting newsletter
BREAKTHROUGH PAIN (BTP) IN CANCER PATIENTS

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.
Future Considerations 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 merits evaluation.

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 This query flows from the observation (unpublished) that at least 50% of cancer patients prefer the second option.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: portenor@mskmail.mskcc.org

Eugene A. Conrad

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

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