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The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients

Opioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed...

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Autores principales: Campagna, Sara, Sperlinga, Riccardo, Milo, Antonella, Sannuto, Simona, Acquafredda, Fabio, Saini, Andrea, Gonella, Silvia, Berruti, Alfredo, Scagliotti, Giorgio Vittorio, Tampellini, Marco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356835/
https://www.ncbi.nlm.nih.gov/pubmed/30586878
http://dx.doi.org/10.3390/cancers11010018
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author Campagna, Sara
Sperlinga, Riccardo
Milo, Antonella
Sannuto, Simona
Acquafredda, Fabio
Saini, Andrea
Gonella, Silvia
Berruti, Alfredo
Scagliotti, Giorgio Vittorio
Tampellini, Marco
author_facet Campagna, Sara
Sperlinga, Riccardo
Milo, Antonella
Sannuto, Simona
Acquafredda, Fabio
Saini, Andrea
Gonella, Silvia
Berruti, Alfredo
Scagliotti, Giorgio Vittorio
Tampellini, Marco
author_sort Campagna, Sara
collection PubMed
description Opioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed at verifying the existence of a circadian rhythm of BTP episodes in terminally-ill cancer patients. Consecutive adult cancer patients at their EOL treated with long-acting major opioids to control background pain (Numeric Rating Scale ≤ 3/10) were recruited from two Italian palliative care services. Using a personal diary, patients recorded the frequency and onset of BTP episodes and the analgesic rescue therapy taken for each episode over a 7-day period. Rhythms identified in BTP episodes were validated by Cosinor analysis. Overall, 101 patients were enrolled; nine died during the study period. A total of 665 BTP episodes were recorded (average of 7.2 episodes, mean square error 0.8) per patient, with 80.6% of episodes recorded between 8:00 a.m. and 12:00 a.m. At Cosinor analysis, a circadian rhythm of BTP episodes was observed, with a Midline Estimating Statistics of the Rhythm (MESOR) of 1.5, a double amplitude of 1.8, and an acrophase at 12:30 p.m. (p < 0.001). Oral morphine was the most frequent analgesic rescue therapy employed. In terminally-ill cancer patients, BTP episodes follow a circadian rhythm; thus, tailoring the timing of opioid administration to this rhythm may prevent such episodes. This circadian rhythm of BTP episodes in terminally-ill cancer patients should be confirmed in larger samples.
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spelling pubmed-63568352019-02-05 The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients Campagna, Sara Sperlinga, Riccardo Milo, Antonella Sannuto, Simona Acquafredda, Fabio Saini, Andrea Gonella, Silvia Berruti, Alfredo Scagliotti, Giorgio Vittorio Tampellini, Marco Cancers (Basel) Article Opioid therapy must be adjusted to the rhythm of a cancer patient’s pain to ensure adequate symptom control at the end of life (EOL). However, to-date no study has explored the rhythm of breakthrough pain (BTP) episodes in terminally-ill cancer patients. This prospective longitudinal study was aimed at verifying the existence of a circadian rhythm of BTP episodes in terminally-ill cancer patients. Consecutive adult cancer patients at their EOL treated with long-acting major opioids to control background pain (Numeric Rating Scale ≤ 3/10) were recruited from two Italian palliative care services. Using a personal diary, patients recorded the frequency and onset of BTP episodes and the analgesic rescue therapy taken for each episode over a 7-day period. Rhythms identified in BTP episodes were validated by Cosinor analysis. Overall, 101 patients were enrolled; nine died during the study period. A total of 665 BTP episodes were recorded (average of 7.2 episodes, mean square error 0.8) per patient, with 80.6% of episodes recorded between 8:00 a.m. and 12:00 a.m. At Cosinor analysis, a circadian rhythm of BTP episodes was observed, with a Midline Estimating Statistics of the Rhythm (MESOR) of 1.5, a double amplitude of 1.8, and an acrophase at 12:30 p.m. (p < 0.001). Oral morphine was the most frequent analgesic rescue therapy employed. In terminally-ill cancer patients, BTP episodes follow a circadian rhythm; thus, tailoring the timing of opioid administration to this rhythm may prevent such episodes. This circadian rhythm of BTP episodes in terminally-ill cancer patients should be confirmed in larger samples. MDPI 2018-12-24 /pmc/articles/PMC6356835/ /pubmed/30586878 http://dx.doi.org/10.3390/cancers11010018 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Campagna, Sara
Sperlinga, Riccardo
Milo, Antonella
Sannuto, Simona
Acquafredda, Fabio
Saini, Andrea
Gonella, Silvia
Berruti, Alfredo
Scagliotti, Giorgio Vittorio
Tampellini, Marco
The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title_full The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title_fullStr The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title_full_unstemmed The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title_short The Circadian Rhythm of Breakthrough Pain Episodes in Terminally-ill Cancer Patients
title_sort circadian rhythm of breakthrough pain episodes in terminally-ill cancer patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356835/
https://www.ncbi.nlm.nih.gov/pubmed/30586878
http://dx.doi.org/10.3390/cancers11010018
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