Dear Editor,
The title of the paper by Sousa et al. [1] on the use of patient-controlled analgesia is misleading, since the majority of the patients in the study appeared to be suffering from uncontrolled background pain rather than “breakthrough pain” [2]. The authors define breakthrough pain as a “transient exacerbation of pain despite the use of around-the-clock analgesia,” and reference the review article by Haugen et al. [3]. However, Haugen et al. concluded that “it is certainly questionable to characterize and treat breakthrough pain (BTP) when baseline pain is not controlled.”
Breakthrough pain is a distinct entity, although the clinical features vary from individual to individual (and can vary within an individual at the same time) [4]. The term should not be used to describe any exacerbation of pain, but restricted to exacerbations of pain that occur in patients with “stable and adequately controlled pain” [2, 3]. The management of breakthrough should be individualized, with the use of rescue medication (including patient-controlled analgesia) being one of many potential therapeutic options [2]. Other therapeutic options include treatment of the underlying cause of the pain, avoidance/treatment of the precipitating factors of the pain, modification of the background analgesic regimen (“around the clock medication”), use of nonpharmacological methods, and use of interventional techniques.
Yours sincerely,
Dr Andrew Davies
References
Sousa AM, de Santana Neto J, Guimaraes GM, Cascudo GM, Neto JO, Ashmawi HA (2014) Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series. Support Care Cancer 22:795–801
Davies AN, Dickman A, Reid C, Stevens A-M, Zeppetella G (2009) The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 13:331–338
Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S (2010) Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 149:476–482
Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W et al (2013) Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manag 46:619–628
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Davies, A. Response to “Safety profile of intravenous patient-controlled analgesia for breathrough pain in cancer patients: a case series study”. Support Care Cancer 22, 2607 (2014). https://doi.org/10.1007/s00520-014-2283-3
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DOI: https://doi.org/10.1007/s00520-014-2283-3