What is it about?
Breakthrough pain (BTP) refers to a transitory exacerbation of pain experienced by a chronic pain (CP) patient who has relatively stable and adequately controlled baseline pain. Variable prevalence and treatment of BTP in different clinical contexts are partially due to the lack of reliable/validated diagnostic tools with prognostic capability. Including BTP in prognosis research may represent a novel approach for BTP recognition and treatment. We report the theoretical background and the steps followed for the development of a scoring system for a BTP diagnostic/prognostic tool based on the naïve Bayes classifier (NBC) approach and the 11-item IQ-BTP validated questionnaire. The tool aims at classifying the potential presence of BTP in three prognostic/likelihood classes: ‘High’, ‘Intermediate’, and ‘Low’. Among patients who potentially experience BTP, the likelihood for the BTP presence is “High,” when both the defined clinical discriminates (frequency and duration) are present; “Intermediate,” if only one is present; and “Low,” if neither are present.
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Why is it important?
BTP requires correct identification and appropriate management. Considering BTP prognostic likelihood may be more useful for formulating clinical issues than for pursuing diagnosis. Based on risk/likelihood features, prognostic information can influence clinical decisions, patient outcome, and cost-effectiveness of care.
Perspectives
The prognostic concepts of potential BTP and of the “High”, “Intermediate,” and “Low” likelihood for the BTP presence may be estimated by the IQ-BTP questionnaire and its scoring system. It is reasonable to speculate that for potential BTP of “High” likelihood, the correct treatment would be Rapid-Onset-Opioids (e.g., transmucosal fentanyl citrate); “Intermediate” or “Low” likelihood imposes careful evaluation of the opportunity to use Short-Acting-Opioids (e.g., oral morphine sulfate) or to ameliorate the ATC opioid regimen, respectively.
Dr Boaz Gedaliahu Samolsky Dekel
Universita degli Studi di Bologna
Read the Original
This page is a summary of: Development and performance of a diagnostic/prognostic scoring system for breakthrough pain, Journal of Pain Research, May 2017, Dove Medical Press,
DOI: 10.2147/jpr.s126132.
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