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Title

Breakthrough pain in elderly patients with cancer: treatment options

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Published in Drugs & Aging. 2014, vol. 31, no. 6, p. 405-411
Abstract The prevalence of pain is high in the elderly and increases with the occurrence of cancer. Pain treatment is challenging because of age-related factors such as co-morbidities, and over half of the patients with cancer pain experience transient exacerbation of pain that is known as breakthrough pain (BTP). As with background pain, BTP should be properly assessed before being treated. The first step to be taken is optimizing around-the-clock analgesia with expert titration of the painkiller. Rescue medication should then be provided as per the requested need, while at the same time preventing identified potential precipitating factors. In the elderly, starting treatment with a lower dose of analgesics may be justified because of age-related physiological changes such as decreased hepatic and renal function. Whenever possible, oral medication should be provided prior to a painful maneuver. In the case of unpredictable BTP, immediate rescue medication is mandatory and the subcutaneous route is preferred unless patient-controlled analgesia via continuous drug infusion is available. Recently, transmucosal preparations have appeared in the medical armamentarium but it is not yet known whether they represent a truly efficient alternative, although their rapid onset of activity is already well recognized. Adjuvant analgesics, topical analgesics, anesthetic techniques and interventional techniques are all valid methods to help in the difficult management of pain and BTP in elderly patients with cancer. However, none has reached a satisfying scientific level of evidence as to nowadays make the development of undisputed best practice guidelines possible. Further research is therefore on the agenda.
Keywords AgedAged, 80 and overAnalgesics, Opioid/administration & dosage/adverse effects/therapeutic useAnti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse effects/therapeutic useBreakthrough Pain/drug therapy/etiologyDrug Therapy, CombinationHumansNeoplasms/complications/drug therapyPain Management/methodsPalliative Care/methodsPractice Guidelines as Topic
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PMID: 24817569
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Article (Published version) (249 Kb) - document accessible for UNIGE members only Limited access to UNIGE
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Research groups Groupe Jean-Michel Gaspoz (23)
Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
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PAUTEX, Sophie Marie, VOGT-FERRIER, Nicole Barbara, ZULIAN, Gilbert. Breakthrough pain in elderly patients with cancer: treatment options. In: Drugs & Aging, 2014, vol. 31, n° 6, p. 405-411. https://archive-ouverte.unige.ch/unige:76762

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Deposited on : 2015-11-02

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