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Palliative Medicine The Research Journal of the EAPC
Article Reviews
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Article Reference |
Reviewer
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| 2004 18(3): |
Caraceni A, Martini C, Zecca E, Portenoy R. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international Survey. Palliative Medicine 2004; 18:177-183 |
Marie Fallon, Edinburgh, UK |
| Background |
An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of breakthrough pain (BKP) as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures, such as pain pathophysiologies and the occurrence of BKP. The clinicians reported BKP in 64.8% of patients. Interestingly, physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes.
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| Clinical Aspects |
| This is a very important study which begins to examine an extremely important clinical problem. BKP is a huge source of patient and carer distress with all the resultant associated problems. |
| Methods and study design |
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The authors are hard on themselves when they say that interpretation of these data is constrained by the survey methodology. They make the point that all patients included were referred to self-identified pain specialists and the study required pain to be severe enough to be treated with opioid analgesics. While in some countries these factors may introduce considerable bias, in other countries, less so. Also BKP was assessed using an observer-rated item, which referred to published experience, but has not been validated.
One of the most interesting findings was the difference in BKP between English-speaking countries and other countries. The international nature of the survey is clearly very important.
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| Comments: Suggestions for further development / Open Questions |
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Perhaps the continued lack of clarity about the term BKP is exaggerated in translation into other languages?
Do we need to refine the definition(s) of BKP so that translation is simplified and an international language can be developed to enable both international research collaborations and meaningful interpretation of data among countries?
Validation of a tool to measure BKP among countries of different languages seems necessary
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