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Table of contents

The NICE guidelines recommend immediate-release of morphine for BTP first-line first-aid drugs and do not provide fentanyl as a first-line rescue drug but morphine. The onset and duration of immediate-release tablets may not be suitable for the treatment of many BTP events [ 27 ]. Oxycodone sustained-release tablets can be used as a two-step drug or as a three-step analgesic drug, which can simultaneously agonize both receptors and K receptor opioid receptors, with high bioavailability and clinical good analgesic effect and less drug-related adverse reactions [ 22 ]; the analgesic intensity is about twice that of morphine immediate-release tablets.

After oral administration, there will be two release phases, which provide early onset of rapid analgesia. The fast release phase and the subsequent sustained-release phase, through the rapid release phase to achieve the purpose of treating burst pain, do not require conversion of the dosage form; clinical application of oxycodone controlled-release tablets is more and more extensive. In order to evaluate the efficacy of oral morphine and oral transmucosal fentanyl preparations to provide further insight into their relative merits as treatments for BTP, we conducted an analysis to compare the effects of fentanyl, morphine, and placebo on BTP indirectly Table 1 , Figures 1 — 6.

The therapeutic effect was evaluated by the difference in pain intensity difference PID score. We found that all opioids provided better analgesic effects during the first hour after dosing, whereas fentanyl may provide a higher level of pain relief than oral morphine. Participants administered a transmucosal fentanyl showed lower pain intensity and higher pain relief at all time points than placebo or oral morphine, and the fentanyl achieved significant pain relief faster.

But there is no significant difference between the various transmucosal fentanyl preparations. From the PID score, the analgesic effect of fentanyl is stronger than oral morphine. However, there are few existing studies, especially regarding the comparison of fentanyl with oral morphine, which is a limitation of this mixed treatment. Moreover, the possibility of systematic differences between undetected data sources for heterogeneity analysis cannot be ruled out.

Putting evidence into practice: Pain

In conclusion, although oral morphine is still an appropriate treatment option for BTP, oral transmucosal fentanyl may be more clinically advantageous in some patients. The recently published guidelines support this approach and recommend the use of fast- or short-acting opioids to treat BTP, whose pharmacodynamics reflect the rapid onset and short duration of pain [ 28 ]. The Cochrane review reported the utility of seven different transmucosal fentanyl compared to oral opioids. Oral and nasal transmucosal fentanyls are an effective treatment for BTP [ 29 ].

The drugs such as fentanyl oral effervescent tablets and fentanyl sublingual tablets have also been approved for use in European and American countries. However, the state of oral mucosa, drug distribution, and oral infections will affect the absorption of drugs, thus affecting the analgesic effect of drugs. Fentanyl nasal spray INFS has been approved by the European Commission in and has been officially used in the clinic. It has been marketed globally and is mainly used for outbreak pain in cancer patients who maintain analgesic treatment with drugs such as oral opioids.

Treatment: nasal mucosal sprays are suitable for those with oral mucosal damage or saliva dysfunction, but those with nasal mucosal bleeding or ulcers need to switch to other treatments [ 30 ]. Both morphine sulfate injection and sufentanil citrate injection can be administered intravenously. Intravenous use of opioids has a fast onset and a positive effect [ 31 , 32 ]. However, it is necessary to evaluate the pain every 15 minutes, and should be alert to the acute side effects of drugs such as respiratory depression [ 32 ], vomiting, dizziness, acute urinary retention, etc. Through these cells with biological micro-pump function, they can continue to secrete analgesic substances to relieve pain or improve pain thresholds, such as serotonin, norepinephrine, dynorphin, enkephalin, neurotrophic factor, etc.

The most extensive and intensive research is the analgesic effect of adrenal chromaffin cells, sympathetic ganglion cells, and some neurotumor cells. Gene therapy refers to a method of achieving analgesic effects by altering gene expression in a patient. In vivo route refers to the direct introduction of therapeutic genes into the body.


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In pain research, there are two main aspects of gene therapy, namely, by upregulating anti-pain gene expression and downregulating pain gene expression, specifically interfering with the biological behavior of pain for therapeutic purposes. Nerve block and nerve damage are one of the main treatments for cancer pain by blocking the pain transmission pathway. The current clinical damage treatment is damage to peripheral nerves, nerve roots, celiac plexus, subarachnoid space, and pituitary gland. Before the operation, physical examination and imaging methods were used to fully determine the pain range of the patient, and the nerves to be controlled were determined.

Under the guidance of CT, the target nerve was destroyed by means of anhydrous alcohol, chemotherapy drugs such as doxorubicin, or physical ablation. Analgesic effect, with positive effect, fast onset, and little effect on other organ functions, has unique advantages for outbreak pain and intractable cancer pain that are ineffective for medical treatment. Currently, nerve blockers or lesions often have anesthesiologists, or the implementation of pain specialists in specialist hospitals has extremely high requirements for the operation of doctors in the positioning of nerves and imaging; otherwise it is likely to cause serious consequences.

Breakthrough cancer pain is a type of problem that clinicians urgently need to solve. There is currently no recognized definition and classification system for cancer BTP, and there are no well-proven BTP assessment tools that pose significant challenges to clinical management. Although breakthrough cancer pain has common clinical features, there are significant differences between individuals, which require clinicians to emphasize the importance of individualized, multidisciplinary analgesic programs on the basis of comprehensive treatment.

In short, the current overall treatment effect of breakthrough cancer pain is not good; it is worthy of our attention. Help us write another book on this subject and reach those readers. Login to your personal dashboard for more detailed statistics on your publications.

Books - Pain Management for Nurses - LibGuides at Mayo Clinic

Edited by Marco Cascella. We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Breakthrough cancer pain has attracted more and more attentions recently because it has become the biggest obstacle to control cancer pain. Keywords breakthrough cancer pain characteristics mechanisms therapy.

Introduction Pain is one of the most common clinical symptoms associated with malignant tumors. Evaluation tools for breakthrough cancer pain For cancer patients, the intensity of pain should be assessed at each visit. This concise yet comprehensive reference on Breakthrough Pain is ideal for palliative care doctors, anesthesiologists, pain medicine specialists and oncologists, as well as for primary care physicians and internists on the frontlines of care.

Breakthrough pain BTP is episodic pain that emerges through the treatment of otherwise well-managed chronic background pain. Often called pain flare or transient pain, BTP negatively affects the function and quality of life of the patient and often results in a number of other physical, psychological and social problems. Breakthrough pain is a common occurrence affecting approximately two-thirds of the estimated 50 to million chronic pain sufferers in the US. It can have multiple causes with various pathophysiologies, and can present with numerous clinical features and complications.

The clinical features vary from individual to individual, and may vary within an individual over time. The successful management of breakthrough pain depends on proper assessment, treatment, and reassessment.

Video abstract

Inadequate assessment can lead to ineffective or inappropriate treatment. Similarly, inadequate reassessment may lead to continuance of ineffective or even harmful treatment. In recent years, the need to educate physicians about pain management has been garnering increased attention from prominent medical associations and the media. Despite ongoing efforts to improve pain treatment, however, the need persists for evidence-based educational materials for physicians in the area of pain diagnosis and management. Proper management, including appropriate pharmacologic management and regional analgesic techniques, can improve function and shorten length of hospital stay.

Patients who are undergoing procedures under sedation or anesthesia need to receive adequate pain relief with drugs or regional anesthetic techniques. In the recovery room following the procedure, the staff taking care of the patient needs to be properly trained to diagnose and treat post-procedural pain. Part of the Oxford American Pain Library, this concise, evidence-based clinical guide serves as a tool for every clinician who wishes to understand the basic mechanisms, pharmacology, invasive and noninvasive treatment modalities, guidelines and development of pain management protocols.

The authors address new technologies, chronic pain issues, running an acute pain service, opioid and non-opioid pharmacology including newly approved drugs , epidural and other regional anesthesia, and special populations such as pediatric patients, the elderly, and patients with a co-existing disease. Other books in this series. Perioperative Pain Management Richard D. Add to basket. Table of contents 1.

Mechanisms of Pain ; 3. Assessment of Pain ; 4.