Vol 12, No 3 (2018)
Review paper
Published online: 2018-10-25
Evaluation and treatment of breakthrough pain in cancer patients
Palliat Med Pract 2018;12(3):156-164.
Abstract
Wstęp: U chorych na nowotwory mogą występować epizody bólu o znacznym natężeniu. Przebijający ból
nowotworowy (BTCP, breakthrough cancer pain) to najczęstsze określenie przemijającego zwiększenia
natężenia bólu, jednakże pomimo przeprowadzenia wielu badań klinicznych, nadal istnieją kontrowersje
dotyczące definicji, epidemiologii i leczenia farmakologicznego BTCP.
Cel pracy: W pracy dokonano przeglądu badań klinicznych dotyczących rozpoznania, oceny klinicznej
i postępowania terapeutycznego u chorych z rozpoznaniem BTCP.
Metody: Przeprowadzono przegląd literatury naukowej z baz Pubmed, MedLine i Embase ze szczególnym
uwzględnieniem definicji, podziału, oceny i leczenia BTCP, zgodnie z wytycznymi Preferred Reporting Items
for Systematic Reviews and Meta-Analyses.
Wyniki: Najlepszym wyborem w terapii BTCP wydaje się być opioid o szybkim początku działania (ROO,
rapid-onset opioid). Produkty fentanylu przewyższają morfinę podawaną drogą doustną zarówno pod
względem skuteczności analgetycznej, jak i szybkości działania. Dostępnych jest niewiele badań klinicznych
porównujących skuteczność różnych produktów fentanylu w leczeniu BTCP. Wybór analgetyku powinien
być dokonywany indywidualnie, w zależności od aktualnego stanu klinicznego pacjenta. Dawka leku
stosowanego w leczeniu BTCP powinna być miareczkowana, jednakże przy początkowej dawce należy
również uwzględnić tolerancję na opioidy podawane długotrwale w leczeniu bólu podstawowego. Algorytmy
rozpoznania BTCP powinny być wykorzystywane wraz z dokładną i kompleksową oceną stanu
klinicznego pacjenta.
Wnioski: Przyszłe badania BTCP powinny dotyczyć opracowania powszechnie akceptowanych definicji
i systemu klasyfikacji BTCP, które umożliwią szczegółowe badania epidemiologii i optymalnego postępowania
w BTCP.
Palliat Med Pract 2018; 12, 3: 156–164
Keywords: breakthrough cancer painrapid-onset opioidintranasal fentanyl sprayopioidsfentanyl
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