Personalised Breakthrough Pain Goals and Responses in Advanced Cancer Patients

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-08-25 DOI:10.1002/ejp.70103

Sebastiano Mercadante, Alesssandra Casuccio, Guglielmo Noce, Claudio Adile

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引用次数: 0

Abstract

Background

The aim of this study was to evaluate patients' global impression (PGI), patient pain goal (PPG), achievement of a patient pain goal response (PPGR) among individuals with advanced cancer admitted to an acute palliative care unit (APCU), after a BTP medication.

Methods

Longitudinal design was employed to assess 230 patients. Changes in BTP, PGI, PPG and PPGR were measured.

Results

BTP intensity (mean, SD) before administration of a BTP medication (T0), 15 min after (T15) and 30 min after (T30) was 6.5 (1.63), 4.3 (1.5) and 2.3 (1.5), respectively. The mean PPG was 1.61 (SD 1.6). Almost all patients reported an improvement in PGI. There were no differences between the different opioids used as BTP medication, and PGGR and PGI (p = 0.728 and p = 0.442, respectively). In the multivariate analysis, higher pain intensity at T0 and lower pain intensity at T30 were independently related to PGI (p < 0.0005). The number of patients who achieved their goals increased at T30 (46.1%); 90.8% of patients reported an improvement in PGI; PPGR was correlated with PPG both at T15 and T30 (p < 0.0005) and was inversely correlated with pain intensity at T15′ (p = 0.001) and T30′ (p < 0.0005).

Conclusion

PPG enables clinicians to individualise patient care and facilitates the assessment of pain response within the same patient over time, ensuring that the evaluation is both clinically relevant and meaningful. Together, the PPG, PGI and PPGR serve as important patient-centred metrics which support pain assessment and inform clinical decision-making in alignment with patients' expectations.

Significance Statement

Patient expectations, expressed as pain goals, are hard to be achieved. Nevertheless, global impression after a breakthrough medication is good, regardless the opioid used.

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晚期癌症患者个性化的突破性疼痛目标和反应

本研究的目的是评估在急性姑息治疗单位（APCU）接受BTP治疗的晚期癌症患者的总体印象（PGI）、患者疼痛目标（PPG）和患者疼痛目标反应（PPGR）的实现情况。方法采用纵向设计对230例患者进行评估。测定BTP、PGI、PPG、PPGR的变化。结果BTP给药前（T0）、给药后15 min （T15）、给药后30 min (T30) BTP强度（SD）均值分别为6.5（1.63）、4.3（1.5）、2.3（1.5）。平均PPG为1.61 （SD 1.6）。几乎所有患者都报告了PGI的改善。不同阿片类药物用于BTP治疗，PGGR和PGI差异无统计学意义（p = 0.728, p = 0.442）。在多变量分析中，T0时较高的疼痛强度和T30时较低的疼痛强度与PGI独立相关（p < 0.0005）。达到目标的患者数量在T30时增加（46.1%）；90.8%的患者报告PGI改善；PPGR与T15和T30时的PPG均相关（p < 0.0005），与T15 ‘和T30 ’时的疼痛强度呈负相关（p < 0.0005）。PPG使临床医生能够个性化患者护理，促进同一患者随时间的疼痛反应评估，确保评估既具有临床相关性又有意义。总之，PPG、PGI和PPGR是重要的以患者为中心的指标，支持疼痛评估，并根据患者的期望为临床决策提供信息。患者的期望，表达为疼痛目标，是很难实现的。然而，突破性药物治疗后的整体印象是好的，不管使用的是阿片类药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.