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Erschienen in: Wiener klinisches Magazin 2/2014

01.04.2014 | Anaesthesie

Durchbruchschmerzen und kurz wirksame Opioide

verfasst von: T. Beutlhauser, J. Oeltjenbruns, Prof. Dr. M. Schäfer

Erschienen in: Wiener klinisches Magazin | Ausgabe 2/2014

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Zusammenfassung

Die bisherige Opioidtherapie besteht in der Gabe retardierter Opioide nach fixem Zeitschema und einer zusätzlich möglichen Bedarfsmedikation. Bei der Notwendigkeit einer Bedarfsmedikation unterscheiden neuere Untersuchungen die nichtausreichende Einstellung der Tagesdosierung oder des Zeitintervalls („end-of-dose failure“) von sog. Durchbruchschmerzen, deren Attacken trotz optimaler Einstellung plötzlich – ereignisabhängig („incident pain“) oder ereignisunabhängig („spontaneous pain“) – auftreten können und üblicherweise nur kurze Zeit andauern. Entsprechend dieser Zeitdynamik scheint eine schnelle und kurzzeitige Erhöhung der Opioidplasmakonzentration sinnvoll zu sein. Obwohl in einer aktuellen europäischen Umfrage die Durchbruchschmerzen der Mehrheit von Tumorpatienten mit nichtretardierten Opioiden zufriedenstellend behandelt wurden, untersucht ein Großteil momentaner klinischer Studien, ob die Anwendung transmukosal- bzw. intranasal-verabreichten Fentanyls aufgrund der verkürzten Zeit bis zur maximalen Plasmakonzentration einen möglichen Vorteil bietet. In diesen Studien zeigt sich zwar ein statistisch signifikanter Unterschied in der Schmerzlinderung und der Anzahl an Schmerzattacken im Vergleich zu nichtretardierten Opioiden, dessen Ausmaß jedoch einen klinischen Vorteil nicht erkennen lässt. Dies mag u. a. daran liegen, dass die Patienten, die möglicherweise davon profitieren könnten, bisher noch nicht eindeutig identifiziert worden sind.
Literatur
1.
Zurück zum Zitat American Pain Society (1992) Principles of analgesics use in acute pain and cancer pain. American Pain Society, Skokie, IL American Pain Society (1992) Principles of analgesics use in acute pain and cancer pain. American Pain Society, Skokie, IL
2.
Zurück zum Zitat Ashburn MA, Slevin KA, Messina J, Xie F (2011) The efficacy and safety of fentanyl buccal tablet compared with immediate-release oxycodone for the management of breakthrough pain in opioid-tolerant patients with chronic pain. Anesth Analg 112:693–702 PubMedCrossRef Ashburn MA, Slevin KA, Messina J, Xie F (2011) The efficacy and safety of fentanyl buccal tablet compared with immediate-release oxycodone for the management of breakthrough pain in opioid-tolerant patients with chronic pain. Anesth Analg 112:693–702 PubMedCrossRef
3.
Zurück zum Zitat Bertram L, Stiel S, Elsner F et al (2010) Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen. Schmerz 24:605–612 PubMedCrossRef Bertram L, Stiel S, Elsner F et al (2010) Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen. Schmerz 24:605–612 PubMedCrossRef
4.
Zurück zum Zitat Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433 PubMedCrossRef Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433 PubMedCrossRef
5.
Zurück zum Zitat Caraceni A, Martini C, Zecca E et al (2004) Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 18:177–183 PubMedCrossRef Caraceni A, Martini C, Zecca E et al (2004) Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 18:177–183 PubMedCrossRef
6.
Zurück zum Zitat Caraceni A, Hanks G, Kaasa S et al (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. J Clin Oncol 13:e58–e68 Caraceni A, Hanks G, Kaasa S et al (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. J Clin Oncol 13:e58–e68
7.
Zurück zum Zitat Coluzzi PH, Schwartzberg L, Conroy JD Jr et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91:123–130 PubMedCrossRef Coluzzi PH, Schwartzberg L, Conroy JD Jr et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91:123–130 PubMedCrossRef
8.
Zurück zum Zitat Darwish M, Kirby M, Robertson P et al (2007) Absolute and relative bioavailability of fentanyl buccal tablet and oral transmucosal fentanyl citrate. J Clin Pharmacol 47:343–350 PubMedCrossRef Darwish M, Kirby M, Robertson P et al (2007) Absolute and relative bioavailability of fentanyl buccal tablet and oral transmucosal fentanyl citrate. J Clin Pharmacol 47:343–350 PubMedCrossRef
9.
Zurück zum Zitat Davies AN, Sitte T, Elsner F et al (2011) Consistency of efficacy, patient acceptability, and nasal tolerability of fentanyl pectin nasal spray compared with immediate-release morphine sulfate in breakthrough cancer pain. J Pain Symptom Manage 41:358–366 PubMedCrossRef Davies AN, Sitte T, Elsner F et al (2011) Consistency of efficacy, patient acceptability, and nasal tolerability of fentanyl pectin nasal spray compared with immediate-release morphine sulfate in breakthrough cancer pain. J Pain Symptom Manage 41:358–366 PubMedCrossRef
10.
Zurück zum Zitat Davies AN, Dickman A, Reid C et al (2009) 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. Eur J Pain 13:331–338 PubMedCrossRef Davies AN, Dickman A, Reid C et al (2009) 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. Eur J Pain 13:331–338 PubMedCrossRef
11.
Zurück zum Zitat Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991 PubMedCentralPubMedCrossRef Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991 PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Felleiter P, Gustorff B, Lierz P et al (2005) Einsatz der WHO-Leitlinien für die Tumorschmerztherapie vor Zuweisung in eine Schmerzklinik. Schmerz 19:265–271 PubMedCrossRef Felleiter P, Gustorff B, Lierz P et al (2005) Einsatz der WHO-Leitlinien für die Tumorschmerztherapie vor Zuweisung in eine Schmerzklinik. Schmerz 19:265–271 PubMedCrossRef
13.
Zurück zum Zitat Fine PG, Messina J, Xie F, Rathmell J (2010) Long-term safety and tolerability of fentanyl buccal tablet for the treatment of breakthrough pain in opioid-tolerant patients with chronic pain: an 18-month study. J Pain Symptom Manage 40:747–760 PubMedCrossRef Fine PG, Messina J, Xie F, Rathmell J (2010) Long-term safety and tolerability of fentanyl buccal tablet for the treatment of breakthrough pain in opioid-tolerant patients with chronic pain: an 18-month study. J Pain Symptom Manage 40:747–760 PubMedCrossRef
14.
Zurück zum Zitat Fisher A, Wattling M, Smith A, Knight A (2010) Pharmacokinetics and relative bioavailability of fentanyl pectin nasal spray 100–800 µg in healthy volunteers. Int J Clin Pharmacol Ther 48:860–870 PubMedCrossRef Fisher A, Wattling M, Smith A, Knight A (2010) Pharmacokinetics and relative bioavailability of fentanyl pectin nasal spray 100–800 µg in healthy volunteers. Int J Clin Pharmacol Ther 48:860–870 PubMedCrossRef
15.
Zurück zum Zitat Haugen DF, Hjermstad MJ, Hagen N et al (2010) Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 149:476–482 PubMedCrossRef Haugen DF, Hjermstad MJ, Hagen N et al (2010) Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 149:476–482 PubMedCrossRef
16.
Zurück zum Zitat Hwang SS, Chang VT, Kasimis B (2003) Cancer breakthrough pain characteristics and responses to treatment at a VA medical center. Pain 101:55–64 PubMedCrossRef Hwang SS, Chang VT, Kasimis B (2003) Cancer breakthrough pain characteristics and responses to treatment at a VA medical center. Pain 101:55–64 PubMedCrossRef
17.
Zurück zum Zitat Jadad AR, Browman JP (1995) The WHO analgesic ladder for cancer pain management. JAMA 274:1870–1873 PubMedCrossRef Jadad AR, Browman JP (1995) The WHO analgesic ladder for cancer pain management. JAMA 274:1870–1873 PubMedCrossRef
18.
Zurück zum Zitat Güttler K (2012) Opioidwirkungen. Anasthesiol Intensivmed Notfallmed Schmerzther 47:224–230 PubMedCrossRef Güttler K (2012) Opioidwirkungen. Anasthesiol Intensivmed Notfallmed Schmerzther 47:224–230 PubMedCrossRef
19.
Zurück zum Zitat Kessler J, Bardenheuer HJ (2011) Cancer breakthrough pain. Indications for rapidly effective opioids. Anaesthesist 60:674–682 PubMedCrossRef Kessler J, Bardenheuer HJ (2011) Cancer breakthrough pain. Indications for rapidly effective opioids. Anaesthesist 60:674–682 PubMedCrossRef
20.
Zurück zum Zitat Kress HG, Orońska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31:1177–1191 PubMedCrossRef Kress HG, Orońska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31:1177–1191 PubMedCrossRef
21.
Zurück zum Zitat Likar R, Sittl R (2007) Praxis der transdermalen Schmerztherapie, 2. Aufl. Unimed, Bremen Likar R, Sittl R (2007) Praxis der transdermalen Schmerztherapie, 2. Aufl. Unimed, Bremen
22.
Zurück zum Zitat Liukas A, Kuusniemi K, Aantaa R et al (2008) Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharmacol Ther 84:462–467 PubMedCrossRef Liukas A, Kuusniemi K, Aantaa R et al (2008) Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharmacol Ther 84:462–467 PubMedCrossRef
23.
Zurück zum Zitat Lötsch J (2005) Pharmacokinetic-pharmacodynamic modeling of opioids. J Pain Symptom Manage 29(5 Suppl):90–102 CrossRef Lötsch J (2005) Pharmacokinetic-pharmacodynamic modeling of opioids. J Pain Symptom Manage 29(5 Suppl):90–102 CrossRef
24.
Zurück zum Zitat Manchikanti L, Singh V, Caraway DL, Benyamin RM (2011) Breakthrough pain in chronic non-cancer pain: fact, fiction, or abuse. Pain Physician 14:E103–E117 PubMed Manchikanti L, Singh V, Caraway DL, Benyamin RM (2011) Breakthrough pain in chronic non-cancer pain: fact, fiction, or abuse. Pain Physician 14:E103–E117 PubMed
25.
Zurück zum Zitat Mercadante S, Fulfaro F (2005) World Health Organization guidelines for cancer pain: a reappraisal. Ann Oncol 16(Suppl 4):1v132–1v135 CrossRef Mercadante S, Fulfaro F (2005) World Health Organization guidelines for cancer pain: a reappraisal. Ann Oncol 16(Suppl 4):1v132–1v135 CrossRef
26.
Zurück zum Zitat Mercadante S (2011) The use of rapid opioids for breakthrough cancer pain: the challenge of its dosing. Crit Rev Oncol Hematol 80:460–465 PubMedCrossRef Mercadante S (2011) The use of rapid opioids for breakthrough cancer pain: the challenge of its dosing. Crit Rev Oncol Hematol 80:460–465 PubMedCrossRef
27.
Zurück zum Zitat McNicol E, Strassels S, Goudas L et al (2004) Nonsteroidal anti-inflammatory drugs, alone or combined with opioids, for cancer pain: a systematic review. J Clin Oncol 22:1975–1992 PubMedCrossRef McNicol E, Strassels S, Goudas L et al (2004) Nonsteroidal anti-inflammatory drugs, alone or combined with opioids, for cancer pain: a systematic review. J Clin Oncol 22:1975–1992 PubMedCrossRef
28.
Zurück zum Zitat McNicol E, Strassels S, Goudas L et al (2005) NSAIDS or paracetamol, alone or combined with opioids, for cancer pain. Cochrane Database Syst Rev 1:CD005180 PubMed McNicol E, Strassels S, Goudas L et al (2005) NSAIDS or paracetamol, alone or combined with opioids, for cancer pain. Cochrane Database Syst Rev 1:CD005180 PubMed
29.
Zurück zum Zitat Müller-Schwefe GH, Müller-Busch C, Überall M et al (2011) Schnell wirksames Fentanyl in der Therapie von Durchbruchschmerzen onkologischer Patienten. Prax Rep 3:1–16 Müller-Schwefe GH, Müller-Busch C, Überall M et al (2011) Schnell wirksames Fentanyl in der Therapie von Durchbruchschmerzen onkologischer Patienten. Prax Rep 3:1–16
30.
Zurück zum Zitat O’Brian CP (2011) Drug addiction. In: Brunton LL, Chabner BA, Knollmann BC (Hrsg) Goodman & Gilman’s The pharmacological basis of therapeutics, 12. Aufl. McGraw-Hill, New York, S 599–668 O’Brian CP (2011) Drug addiction. In: Brunton LL, Chabner BA, Knollmann BC (Hrsg) Goodman & Gilman’s The pharmacological basis of therapeutics, 12. Aufl. McGraw-Hill, New York, S 599–668
31.
Zurück zum Zitat Oeltjenbruns J, Kopf A (2010) Pharmakotherapie des Durchbruchschmerzes: state of the art. Pharma Fokus Schmerzther 1:7–12 Oeltjenbruns J, Kopf A (2010) Pharmakotherapie des Durchbruchschmerzes: state of the art. Pharma Fokus Schmerzther 1:7–12
32.
Zurück zum Zitat Passik SD, Messina J, Golsorkhi A, Xie F (2011) Aberrant drug-related behavior observed during clinical studies involving patients taking chronic opioid therapy for persistent pain and fentanyl buccal tablet for breakthrough pain. J Pain Symptom Manage 14:116–124 CrossRef Passik SD, Messina J, Golsorkhi A, Xie F (2011) Aberrant drug-related behavior observed during clinical studies involving patients taking chronic opioid therapy for persistent pain and fentanyl buccal tablet for breakthrough pain. J Pain Symptom Manage 14:116–124 CrossRef
33.
Zurück zum Zitat Pergolizzi J, Böger RH, Budd K et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313 PubMedCrossRef Pergolizzi J, Böger RH, Budd K et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313 PubMedCrossRef
34.
Zurück zum Zitat Petzke F, Radbruch L, Zech D et al (1999) Temporal presentation of chronic cancer pain: transitory pain on admission to a multidisciplinary pain clinic. J Pain Symptom Manage 17:391–401 PubMedCrossRef Petzke F, Radbruch L, Zech D et al (1999) Temporal presentation of chronic cancer pain: transitory pain on admission to a multidisciplinary pain clinic. J Pain Symptom Manage 17:391–401 PubMedCrossRef
35.
Zurück zum Zitat Portenoy RK, Hagen NA (1990) Breakthrough pain. Definition, prevalence characteristics. Pain 41:273–281 PubMedCrossRef Portenoy RK, Hagen NA (1990) Breakthrough pain. Definition, prevalence characteristics. Pain 41:273–281 PubMedCrossRef
36.
Zurück zum Zitat Portenoy RK, Payne D, Jacobson P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81:129–134 PubMedCrossRef Portenoy RK, Payne D, Jacobson P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81:129–134 PubMedCrossRef
37.
Zurück zum Zitat Portenoy RK, Payne R, Coluzzi P et al (1999) Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: a controlled dose titration study. Pain 79:303–312 PubMedCrossRef Portenoy RK, Payne R, Coluzzi P et al (1999) Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: a controlled dose titration study. Pain 79:303–312 PubMedCrossRef
38.
Zurück zum Zitat Davies A (Hrsg) (2006) Cancer-related breakthrough pain. Oxford University Press, Oxford Davies A (Hrsg) (2006) Cancer-related breakthrough pain. Oxford University Press, Oxford
39.
Zurück zum Zitat Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manage 6:97–108 CrossRef Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manage 6:97–108 CrossRef
40.
Zurück zum Zitat Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 2: impact on function, mood, and quality of life. J Opioid Manage 6:109–116 CrossRef Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 2: impact on function, mood, and quality of life. J Opioid Manage 6:109–116 CrossRef
41.
Zurück zum Zitat Portenoy RK, Burton AW, Gabrail N et al (2010) A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain 151:617–624 PubMedCrossRef Portenoy RK, Burton AW, Gabrail N et al (2010) A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain 151:617–624 PubMedCrossRef
42.
Zurück zum Zitat Radbruch L, Torres LM, Ellershaw JE et al (2012) Long-term tolerability, efficacy and acceptability of fentanyl pectin nasal spray for breakthrough cancer pain. Support Care Cancer 20:565–573 PubMedCrossRef Radbruch L, Torres LM, Ellershaw JE et al (2012) Long-term tolerability, efficacy and acceptability of fentanyl pectin nasal spray for breakthrough cancer pain. Support Care Cancer 20:565–573 PubMedCrossRef
43.
Zurück zum Zitat Raffa RB, Pergolizzi J (2010) Opioid formulations designed to resist/deter abuse. Drugs 70:1657–1675 PubMedCrossRef Raffa RB, Pergolizzi J (2010) Opioid formulations designed to resist/deter abuse. Drugs 70:1657–1675 PubMedCrossRef
44.
Zurück zum Zitat Rauck RL, Tark M, Reyes E et al (2009) Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 25:2877–2885 PubMedCrossRef Rauck RL, Tark M, Reyes E et al (2009) Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 25:2877–2885 PubMedCrossRef
45.
Zurück zum Zitat Rodriguez RF, Bravo LE, Castro F et al (2007) Incidence of weak opioids adverse events in the management of cancer pain: a double-blind comparative trial. J Palliat Med 101:56–60 CrossRef Rodriguez RF, Bravo LE, Castro F et al (2007) Incidence of weak opioids adverse events in the management of cancer pain: a double-blind comparative trial. J Palliat Med 101:56–60 CrossRef
46.
Zurück zum Zitat Sabatowski R, Arens ER, Waap I, Radbruch L (2001) Tumorschmerztherapie in Deutschland. Schmerz 15:241–247 PubMedCrossRef Sabatowski R, Arens ER, Waap I, Radbruch L (2001) Tumorschmerztherapie in Deutschland. Schmerz 15:241–247 PubMedCrossRef
47.
Zurück zum Zitat Shibutani K, Inchiosa MA Jr, Sawada K, Bairamian M (2005) Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients. Br J Anaesth 95:377–383 PubMedCrossRef Shibutani K, Inchiosa MA Jr, Sawada K, Bairamian M (2005) Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients. Br J Anaesth 95:377–383 PubMedCrossRef
48.
Zurück zum Zitat Svendsen KB, Andersen S, Arnason S et al (2005) Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 9:195–206 PubMedCrossRef Svendsen KB, Andersen S, Arnason S et al (2005) Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 9:195–206 PubMedCrossRef
49.
Zurück zum Zitat Tassinari D, Drudi F, Rosati M et al (2011) The seccond step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain: a systematic review. Palliat Med 25:410–423 PubMedCrossRef Tassinari D, Drudi F, Rosati M et al (2011) The seccond step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain: a systematic review. Palliat Med 25:410–423 PubMedCrossRef
50.
Zurück zum Zitat World Health Organization (1990) Cancer pain relief and palliative care: report of a WHO Expert Committee. WHO Technical Report Series 804. World Health Organization, Geneva World Health Organization (1990) Cancer pain relief and palliative care: report of a WHO Expert Committee. WHO Technical Report Series 804. World Health Organization, Geneva
51.
Zurück zum Zitat Zech DFJ, Grond S, Lynch J et al (1995) Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76 PubMedCrossRef Zech DFJ, Grond S, Lynch J et al (1995) Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76 PubMedCrossRef
52.
Zurück zum Zitat Zeppetella G (2009) Breakthrough pain should be distinguished from background pain. Guidelines in Practice 12:1–5 Zeppetella G (2009) Breakthrough pain should be distinguished from background pain. Guidelines in Practice 12:1–5
53.
Zurück zum Zitat Zeppetella G (2011) Opioids for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioid guidelines project. Palliat Med 25:516–524, World Health Organization. Cancer pain relief and palliative care. WHO, Geneva, 1990 PubMedCrossRef Zeppetella G (2011) Opioids for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioid guidelines project. Palliat Med 25:516–524, World Health Organization. Cancer pain relief and palliative care. WHO, Geneva, 1990 PubMedCrossRef
Metadaten
Titel
Durchbruchschmerzen und kurz wirksame Opioide
verfasst von
T. Beutlhauser
J. Oeltjenbruns
Prof. Dr. M. Schäfer
Publikationsdatum
01.04.2014
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 2/2014
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-014-0212-1

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