Article
Pharmacology & Pharmacy
Sebastiano Mercadante, Russell K. Portenoy
Summary: Breakthrough cancer pain (BTcP) is a complex phenomenon that varies between individuals and may change over time. Personalized management requires appropriate assessment of BTcP patterns. The use of opioids, specifically fentanyl products with rapid onset and offset, is recommended. The optimal opioid dose remains a controversial topic, with conflicting recommendations regarding dosing strategies.
Review
Health Care Sciences & Services
Marco Cascella, Federica Monaco, Davide Nocerino, Elisabetta Chine, Roberta Carpenedo, Paola Picerno, Laura Migliaccio, Angela Armignacco, Giulia Franceschini, Sergio Coluccia, Piergiacomo Di Gennaro, Maura C. Tracey, Cira A. Forte, Mariangela Tafuri, Anna Crispo, Francesco Cutugno, Alessandro Vittori, Silvia Natoli, Arturo Cuomo
Summary: The study conducted a bibliometric network analysis on the use of ROOs for BTcP treatment, revealing trends in published articles, distribution in journals, and main research topics. Most articles focused on the efficacy of ROOs, while abuse and misuse issues were not sufficiently addressed. Additionally, the semantic network analysis showed connections between breakthrough cancer pain, opioids, and cancers.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
(2022)
Article
Medicine, General & Internal
Sebastiano Mercadante, Augusto Caraceni, Arturo Cuomo, Massimo Mammucari, Paolo Marchetti, Rocco Domenico Mediati, Silvia Natoli, Giuseppe Tonini
Summary: After one-month follow-up, cancer patients experienced a lower number of breakthrough pain episodes and peak intensity, potentially due to optimization of background analgesia. The principal characteristics of breakthrough pain did not change significantly, highlighting the importance of careful and continuous assessment for patients to alleviate the burden induced by breakthrough pain episodes.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Health Care Sciences & Services
Tsung-Che Wu, Chih-Hung Hsu, Wei-Zen Sun, Ho-Min Chen, Chih-Peng Lin, Yu-Yun Shao
Summary: The introduction of new strong opioids in Taiwan led to changes in opioid prescription patterns for cancer pain management, aligning more with international guidelines. While the use of strong opioids increased, the use of weak opioids decreased.
LANCET REGIONAL HEALTH-WESTERN PACIFIC
(2021)
Article
Oncology
Sebastiano Mercadante, Marco Maltoni, Domenico Russo, Claudio Adile, Patrizia Ferrera, Romina Rossi, Marta Rosati, Alessandra Casuccio
Summary: In patients receiving low doses of opioids, the prevalence of breakthrough cancer pain (BTcP) was high, with many patients experiencing dissatisfaction with BTcP medications, especially oral morphine. Optimizing background analgesia may help limit the number of BTcP episodes.
Article
Oncology
Paula Gonzalez Villarroel, Josep Guma Padro, Gloria Marquina, Noelia Martinez Janez, Emilio Esteban Gonzalez, Antonio Anton, Miguel Berzosa Sanchez, Alberto Rodrigo Caceres, Rafael Lopez-Lopez, Roberto Escala Cornejo, Pablo Borrega Garcia, Raquel Marse Fabregat, Beatriz Castelo Fernandez, Cristina Lopez Bermudo, Carlos Camps
Summary: This study evaluated the quality of life in patients with BTcP in Spanish medical oncology departments. The results showed that individualized BTcP therapy could improve patients' QoL.
Article
Psychology, Biological
Michael M. Morgan, Tammy N. Hilgendorf, Ram Kandasamy
Summary: This study investigated the effects of fentanyl on hindpaw inflammation, administration, and withdrawal in rats. The results showed that the effects of fentanyl on activity levels varied depending on the dose and pain condition, and withdrawal from fentanyl resulted in opioid withdrawal symptoms.
PHYSIOLOGY & BEHAVIOR
(2023)
Article
Neurosciences
Angela E. Barattini, Christian Montanari, Kimberly N. Edwards, Scott Edwards, Nicholas W. Gilpin, Amanda R. Pahng
Summary: The current opioid epidemic is a national health crisis with increasing reports of opioid misuse and overdose deaths. Prescription opioids are the most powerful and effective medications for pain treatment, but their risk of misuse needs to be investigated in adults with chronic pain. This study found that chronic inflammatory pain did not affect fentanyl intake or motivation for drug seeking, but it increased the rewarding properties of low-dose fentanyl in males. Both sexes showed increased motivation for fentanyl as the dose decreased. These findings suggest that established fentanyl self-administration is resistant to change by inflammatory pain, but chronic inflammatory pain may increase the risk of fentanyl misuse in males.
Article
Oncology
Albert Tuca Rodriguez, Miguel Nunez Viejo, Pablo Maradey, Jaume Canal-Sotelo, Placido Guardia Mancilla, Sonia Gutierrez Rivero, Inmaculada Raja Casillas, Maria Herrera Abian, Cristina Lopez Bermudo
Summary: Individualized management of breakthrough cancer pain (BTcP) can improve quality of life (QoL) for patients with advanced cancer, with transmucosal fentanyl at low doses being the most common drug used.
SUPPORTIVE CARE IN CANCER
(2021)
Article
Emergency Medicine
Raoul Daoust, Jean Paquet, Verilibe Huard, Jean-Marc Chauny, Gilles Lavigne, David Williamson, Manon Choiniere, Eddy Lang, Justin W. Yan, Jeffrey J. Perry, Marcel Emond, Sophie Gosselin, Alexis Cournoyer
Summary: This study aimed to evaluate the relationship between emergency department (ED) acute pain management with fentanyl compared to other opioids, and the quantity of opioids consumed by patients two weeks after discharge. The results showed that patients treated with fentanyl during their ED stay did not consume more opioids after ED discharge, compared to those treated with other opioids.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Oncology
Marco Mazzotta, Marco Filetti, Marta Piras, Sebastiano Mercadante, Paolo Marchetti, Raffaele Giusti
Summary: This study aims to identify factors that can predict patients' satisfaction with pain relief for breakthrough cancer pain (BTcP). The results showed that younger age, non metastatic cancer stage, high Karnofsky performance status, absence of anticancer treatment, and high BTcP interference in activities of daily living were positively correlated with dissatisfaction.
CANCER MANAGEMENT AND RESEARCH
(2022)
Article
Oncology
Albert Tuca Rodriguez, Miguel Nunez Viejo, Pablo Maradey, Jaume Canal-Sotelo, Placido Guardia Mancilla, Sonia Gutierrez Rivero, Inmaculada Raja Casillas, Maria Herrera Abian, Cristina Lopez Bermudo
Summary: The study demonstrated that low-dose sublingual fentanyl effectively reduced breakthrough cancer pain in advanced cancer patients in palliative care units in Spain, significantly improving quality of life.
Editorial Material
Oncology
D. Max Smith, William D. Figg
Summary: This commentary reviews a recent trial on the relationship between COMT genotype and opioid dose requirements, and discusses the potential role of COMT and other genes (such as CYP2D6) in opioid therapy. It also provides an overview of the current evidence for germline pharmacogenetics and available resources for opioid pharmacogenetics.
Review
Anesthesiology
Thomas Cheriyan, Mohamed Gaber, Taylor Glenn, John Latremouille, Kayla L. Loy, Jerry Cheriyan, Anterpeet Dua, Paramvir Singh, Vikas Kumar, Mohamed Ben Omran
Summary: This meta-analysis compares the efficacy of intraoperative methadone with other opioids on postoperative outcomes. The results show that there is no significant reduction in opioid consumption postoperatively between the groups. However, pain scores within 24 hours were significantly lower in the methadone group. There was no difference in secondary outcomes such as extubation time, nausea, vomiting, and respiratory depression.
Review
Medicine, General & Internal
Franco Marinangeli, Annalisa Saetta, Antonio Lugini
Summary: Despite dedicated laws and effective treatments in Italy, a low percentage of specialists assess pain and BTcP with validated tools, and undertreatment of cancer pain remains prevalent globally. A multidisciplinary approach, more training programs for clinicians, personalized therapy drug formulations, and virtuous care pathways are essential for improving cancer pain management.