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RL: Revisones 2019
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Recommendations for the treatment of BTCP
The limitation of the tests means that the grade of recommendation for the treatment of BTCP is D,
except for the need for titration of immediate-release fentanyl (recommendation grade B for one author
[23], although this is questionable). In general, we recommend the following:
– It is necessary to diagnose and treat the BTCP as soon as it appears.
– The treatment must be adapted to the physiopathology of the pain.
– The treatment is complementary to the opioid-based treatment used for chronic pain.
– It is important to differentiate incidental pain from spontaneous pain, as the former can and should be
prevented.
– Rapid-release morphine is useful for incidental pain as its use can be adapted to the expected onset
time of the pain.
– For spontaneous pain, the ideal drugs are the various forms of rapid-release fentanyl.
– All these must be titrated in increasing doses for each patient until reaching minimum efficacy to control
pain.
– Remember the non-drug measures that can help with BTCP.
– Monitor both response and side effects.