September 2002

Dear Readers: Here's the Article for this Month:

Name of article: 

EPISODIC (BREAKTHROUGH) PAIN
Consensus Conference of an Expert Working Group of the European Association for Palliative Care

Author(s): Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, Ripamonti C, De Conno F and the Steering Committee of the EAPC Research Network

Reference: Cancer 2002; 94: 832-9

Abstract:

Breakthrough pain (BP) is a transitory exacerbation of pain in addition to constant and persistent pain . The major differences reported in literature regarding the evaluation of the incidence of breakthrough pain are most probably due to the various care settings and the various definitions given to BP . A group of experts met with the purpose of collecting and reviewing knowledge regarding BP, according to evidence in literature and personal experience. 
There was a unanimous agreement that "episodic pain" or "transitory pain" could be the most suitable expression, very simple and appropriate in many languages english, french, italian and spanish. A specific evaluation with the validated assessment tools (basic pain intensity, localization-frequency-intensity-duration-quality of the transitory pain, soothing and precipitant factors, spontaneous regression or regression due to specific treatment, length of efficacy) and a precise pain trait (nociceptive versus neuropathic) are of utmost importance to plan the most appropriate treatment. 
In spite of the clinical importance of this temporary pain stimulus on the worsening of life quality, few controlled studies have been carried out offering scientific evidence for a specific approach (or treatment). In the article, experience regarding the efficacy of various drugs, routes and modalities of administration in different circumstances and neuroinvasive techniques have been examined and reported. 

Why I chose this Article:

Episodic or transitory pain is reported as having an incidence of 40-80% and is usually difficult to control.

This article offers :
** a list of the various reasons of episodic pain differentiating it in association and non-association with movement 
** guidelines of evaluation and classification of episodic pain
** an algorithm for the treatment of episodic pain divided in somatic and neuropathic pain

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC