Break Through Cancer Pain, BTcP

1. The breakthrough cancer pain is a worsening stage of the underlying pain, rapid onset and limited duration (less than 45 minutes), in patients under opioid therapy. This pain may be due to the neoplastic disease itself, to other diseases or to the medication used to treat it 2.

Opioids Induced Constipation, OIC

Constipation is considered a common side effect associated with opioid administration for pain management, which is usually moderate to severe and is associated with cancer or other chronic non-oncological conditions3.

Post Operative Nausea & Vomiting, PONV

The post-operative nausea and vomiting (PONV) is one the most frequent and unpleasant complications after general anesthesia for a surgical operation 4. Persistent or severe PONV can cause medical complications such as dehydration, electrolyte disturbances, and delayed patient bowel movements5. The overall impact of PONV, a determinant of patient outcome and satisfaction, has been reported to range from 10% to 79%6.

Patient-controlled analgesia, PCA

A device containing anesthetic is attached to the intravenous catheter or even to a subcutaneous catheter. When the patient is in pain, he presses a button and injects a dose of medicine intravenously. It is possible to adjust the dose and frequency of response to avoid overdose of the drug. This pump should only be used by the patient and not by another person in order to avoid unnecessary medication administration. The drugs commonly used in this technique are morphine, pethidine and fentanyl7. Some patients experiencing nausea, vomiting, pruritus, urinary retention and constipation following opioids administration8.

Pain assessment and therapeutic goals

Acute pain is usually caused by an acute illness or injury. Typically, there is no psychological element. Therapeutic goals for acute pain begin with timely intervention, with immediate adjustments regarding treatment regimen for adequate pain control. Other goals include reducing pain to an acceptable level and facilitating recovery from the underlying illness or injury 9,10

Chronic pain can be related to cancer or non-cancerous causes. Often there is a psychological component. Therapeutic goals of chronic pain include reducing pain and thus reducing patient’s suffering, improving their ability to cope with the development of self-help strategies, reducing dependence on health care systems and improving relationships (such as family, friends and health care professionals) 9,10.

The above information is intended for general information of the public and in no case can replace the advice of a doctor or other competent health professional.

1. Davis MWD. American Journal of hospice and palliative medicine 2004; 21 (2): 137- 142.
2. Portenoy RK et al. Pain. 2010 Dec;151(3):617-24. ePub 2010 Aug 25.
3. Panchal SJ et al. Int J Clin Pract. 2007; 61:1181-7.
4. Golembiewski J et al. Am J Health Syst Pharm 2005; 62: 1247-60.
5. Muchatuta NA et al. Ther Clin Risk Manag 2009; 5: 21-34.
6. Apfel CC et al. Anesthesiology 1999; 91: 693-700.
7. Harmer Μ, Rosen Μ, Vickers MD. Patient-controlled analgesia. Proceedings of the 1st International Workshop on PCA. Kent, 1984. Blackwell Scientific Publications.
8. Bahar Μ, Rosen Μ, Vickers MD. Self-administered nalbuphine morphine and pethidine. Comparison by intravenous route following cholecystectomy. Anaesthesia 1985; 40: 529-532.
9. Baumann TJ et al. Classification of pain. In: Pharmacotherapy: A Pathophysiological Approach. 8th ed. New York, NY: The McGraw-Hill Companies, Inc; 2011.
10. American Pain Society. Pain: Current Understanding of Assessment, Management, and Treatments; 2001.