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Conrad Notes IndexspacerAmerican Pain Society Meeting Index

Conrad Notes
a timely medical meeting newsletter

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 This query flows from the observation (unpublished) that at least 50% of cancer patients prefer the second option.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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