I am delighted to announce the exciting news that we have received just under 900 abstracts for presentation in the scientific program of the VIth World Congress on Pain in Adelaide, April l-6, 1990. This 1s about a 50% increase in the number of abstracts submitted for the 1987 Congress in Hamburg and it represents by far the greatest number of scientific papers ever offered for the an IASP Congress. This surely reflects the healthy state of IASP and is also a very encouraging indlcator of the high level of activity in basic and clinical research in the field of pain throughout the world. Based upon our previous experience with the ratio of congress delegates to scientific abstracts, the Adelaide Congresses promises to be the largest world congress on pain we have so far held.

International association for the study of pain

The management of cancer-related breakthrough pain: Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland

BACKGROUND

Breakthrough pain is transitory exacerbation of pain that occurs in addition to otherwise stable persistent pain. The wide differences in estimation of incidence reported in literature are probably because of different settings and meanings attributed to the definition of breakthrough pain.



METHODS

A panel of experts met to establish the actual knowledge on breakthrough pain, according to the evidence in literature and experience. They agreed that episodic or transient pain could be a more simple and adequate term in most languages, including English, French, Italian, and Spanish.



RESULTS

A specific assessment and precise pain characterization are essential to plan the most appropriate treatments. Despite the relevance of this temporal pain pattern for the influence on the outcome and quality of life, few controlled studies have been performed to give evidence of a specific approach. Several experiences have reported the possible efficacy of different drugs, route of administration, and modalities of administration in different circumstances.



CONCLUSIONS

Prospective studies with previous treatments using similar terminologies are necessary to find the most convenient therapeutic intervention, according to the temporal pattern characteristics and the pain mechanism involved. Cancer 2002;94:832–9. © 2002 American Cancer Society.



DOI 10.1002/cncr.10249

Episodic (Breakthrough) Pain Consensus Conference of an Expert Working Group of the European Association for Palliative Care

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

/pdf/breakthrough-pain-characteristics-and-syndromes-in-patients-2lm6ppoizo.pdf

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey.

We identified 28 epidemiological surveys by applying a sensitive search in Medline and CancerLit databases, supplemented by hand searches. Only two surveys enrolled more than 10,000 patients with cancer. The remaining were hospital or clinic-based surveys of at most a few hundred patients. Fourteen surveys were conducted in the United States. The majority of the remaining studies were conducted in Europe (Finland, France, Germany, UK/Ireland). No single survey identified a prevalence of any type of pain below 14%. The prevalence of pain reported in these surveys varies with the specific type of pain (e.g., breakthrough pain) and/or population studied. Based on these surveys an aggregate statement could not be deduced regarding the correlation between the occurrence of pain and patient factors, disease characteristics, the setting in which care is provided (e.g., primary care or specialized oncology or pain treatment clinics), or specific treatments directed towards the underlying disease and its associated pain. However, these surveys suggest that a significant number of patients with cancer worldwide will, during the course of their disease, experience pain that requires medical and/or other treatment.

The epidemiology of cancer pain.

https://www.jpsmjournal.com/article/S0885-3924(00)00161-5/pdf

Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice.

A prospective survey was undertaken to determine the prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice. Of the 78 admissions surveyed, 10 patients were confused or too unwell to take part and 25 were pain-free. The remaining 43 reported 86 pains (range 1–6 per patient); of these patients, 27 (63%) had breakthrough pain and identified 52 pains (range 1–5 per patient). Breakthrough pain was classified as somatic (46%) visceral (14%), neuropathic (25%) or mixed aetiology (15%); 60% of pains were severe or excruciating. The mean number of daily breakthrough pain episodes was five (range 1–13), 54% of which occurred suddenly. Most pains (56%) were unpredictable; 75% lasted less than 30 min. These findings suggest that breakthrough pain is common in patients with non-malignant terminal disease; it is frequent, short lasting and often unpredictable, thus making treatment difficult.

Prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice

Multi-cancer early detection test in symptomatic patients referred for cancer investigation in England and Wales (SYMPLIFY): a large-scale, observational cohort study.

1501 Background: Delays in cancer diagnosis can lead to increased mortality, leading to specialized diagnostic pathways for symptomatic patients when cancer is suspected. Identification of circulating tumour DNA can stratify individuals into those more or less likely to have cancer and predict the cancer origin. This could both expedite cancer diagnosis and reduce harm and inefficient investigation in those who do not have cancer. We evaluated the performance of a next-generation sequencing MCED test (GRAIL, LLC) using cell-free DNA (cfDNA) isolated from whole blood in symptomatic patients referred to cancer diagnostic clinics by their primary care physician. Methods: Patients referred for urgent imaging, endoscopy or other diagnostic modalities to investigate symptoms suspicious for cancer were invited to take part. Participants with non-specific symptoms or being tested for lung, gynaecological, upper gastrointestinal (GI) or lower GI cancers gave a blood sample on the day they attended for urgent standard of care investigations. cfDNA was isolated from blood samples and stored until the MCED test was performed in batches, blinded to clinical outcome. The test’s predictions (cancer signal detected yes/no; predicted signal origin) were compared with the diagnosis obtained by standard care to establish the positive and negative predictive value (PPV & NPV), sensitivity and specificity across the whole study population, by referral pathway, and by presenting symptom. In addition, sensitivity was analysed by cancer site and stage. Results: 6238 participants were recruited over 5 months from the 5 clinical pathways at 44 hospital sites in England and Wales. 5461 individuals had an MCED test result and diagnostic outcome and were evaluable. Mean age was 62.1 years (SD, 13.8), 3609 (66.1%) female, 2533 (46.4%) current or former smokers. 368 (6.7%) evaluable patients had a cancer diagnosed. The MCED test detected a cancer signal in 323 cases, 244 in whom cancer was diagnosed and 79 where it was not, yielding a PPV of 75.5% (95% CI 70.5-80.1%), NPV 97.6% (97.1-98.0%), sensitivity 66.3% (61.2-71.1%), and specificity 98.4% (98.1-98.8%). Sensitivity increased with increasing age and cancer stage, from 24.2% (16.0-34.1%) in Stage I to 95.3% (88.5-98.7%) in Stage IV. Sensitivity 80.4% (66.1-90.6%) and NPV 99.1% (98.2-99.6%) were highest for patients referred with symptoms qualifying for the upper GI pathway. Conclusions: This is the first large-scale prospective evaluation of an MCED test in a symptomatic population. These data provide the basis for a prospective, interventional study in patients presenting to primary care with non-specific signs and symptoms with low, but higher than background, probability of being due to cancer. Study data are also being used to enhance the negative predictive value of the current MCED classifier for a symptomatic population. Clinical trial information: ISRCTN10226380 .

Large-scale observational prospective cohort study of a multi-cancer early detection (MCED) test in symptomatic patients referred for cancer investigation.

Catherine A O'Doherty

Papers

Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice.

Prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice

Multi-cancer early detection test in symptomatic patients referred for cancer investigation in England and Wales (SYMPLIFY): a large-scale, observational cohort study.

Large-scale observational prospective cohort study of a multi-cancer early detection (MCED) test in symptomatic patients referred for cancer investigation.