Pain therapy

Comprehensive solutions for the management of breakthrough, chronic, and acute pain.

Pain therapy

Pain management is a multidisciplinary approach aimed at reducing suffering and improving quality of life. In oncology, pain is an omnipresent burden, yet it remains one of the most critically undertreated symptoms in modern medicine, leaving nearly 40% of patients without adequate relief.
Pain is a massive clinical reality, affecting up to 74% of patients with advanced or metastatic cancer. It tracks the entire oncological journey, from active treatment through to the palliative phase, and frequently persists into survivorship due to therapy-induced nerve damage.

Breakthrough cancer pain

Breakthrough Cancer Pain (BTcP) is a transient exacerbation of pain that occurs despite relatively stable and adequately controlled background pain. It is characterized by high intensity, rapid onset (typically <3–5 minutes), and short duration.​
Due to its unpredictable nature, BTcP requires specific medication, such as rapid-onset opioids (ROOs) that can mimic the temporal profile of the pain flare.

Chronic pain​

Chronic pain is defined as pain that persists or recurs for more than 3 months. It is no longer a mere symptom but is recognized as a distinct disease entity (ICD-11). It often involves a combination of neuropathic and inflammatory mechanisms, leading to significant functional impairment and psychological distress.​
Management requires a biopsychosocial model to address the long-term impact on the patient’s life.

Acute pain​

Acute pain is a physiological response to noxious stimuli, typically characterized by a sudden onset and a limited duration. It serves as a vital biological warning signal related to surgery, trauma, or acute illness.​
If inadequately managed, acute pain can trigger complex neuroendocrine responses and significantly increase the risk of transition into chronic pain states through neuronal sensitization.​

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References

  • Chou, R et al. Management of Postoperative Pain: A Clinical Practice Guideline. J Pain. 2016 Feb;17(2):131-57.​
  • Davies, AN et al. Management of breakthrough cancer pain: recommendations from a European task force. Eur J Pain. 2009 Apr;13(4):331-8.​
  • Greco, MT et al. Quality of cancer pain management: an updated systematic review and meta-analysis. Journal of Clinical Oncology. 2014 Dec 20;32(36):4149-4154.
  • Grichnik, KP & Ferrante, FM. The difference between acute and chronic pain. Mt Sinai J Med. 1991 May;58(3):217-20.​
  • Kehlet, H et al. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006 May 13;367(9522):1618-25.​
  • Mercadante S. Breakthrough cancer pain: a critical review. Critical Reviews in Oncology/Hematology. 2012 82(3), 330-341.​
  • Nicholas, M et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019 Jan;160(1):28-37.​
  • Raja, SN et al. The revised IASP definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976–1982.​
  • Treede, RD et al. A classification of chronic pain for ICD-11. Pain. 2015 Mar 14;156(6):1003–1007.
  • van den Beuken-van Everdingen, MH et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Journal of Pain and Symptom Management. 2007 Mar;33(3):323-330.
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