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Introduction The literature lacks formally validated and reliable tools for the diagnosis of breakthrough cancer pain (BTcP). The Italian Questionnaire for BTcP diagnosis (IQ-BTP) is an 11-item questionnaire aimed at detecting potential-BTP and classifying it into three likelihood classes: high, intermediate, and low. Methods A multicenter, prospective, and observational study was designed to validate the IQ-BTP. In three consecutive visits with each cancer patient, the demographic and clinical details of the patient, the Brief Pain Inventory (BPI) scores, IQ-BTP outcomes, and clinicians' autonomous BTcP diagnosis (gold standard) and the agreement of this diagnosis with IQ-BTP outcomes were recorded. The assessed domains for IQ-BTP validation were: Validity, including content and face validity, construct validity (hypothesis testing, and cross‐cultural validity\measurement invariance), and criterion validity; Reliability (internal consistency, reliability, and measurement error); Interpretability, and Responsiveness. Results Seven palliative and pain management facilities in Italy recruited 280 patients, yielding 753 evaluations. Using the IQ-BTP, the rate of potential-BTcP was 27.2%, of which its likely presence was high in 52.7% of patients, intermediate in 38.5, and low in 8.8%. The BPI item scores differed significantly between the two IQ-BTP classes (no-BTcP and potential-BTcP classes). The correlation of the latter class with BPI items was significant but low. The IQ-BTcP showed two principal components, accounting for 66.6% of the variance. Cronbach’s α was 0.71. The agreement rate between the gold standard and IQ-BTP outcomes was 82%. Cohen's \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\kappa$$\end{document}κ was 0.535. The IQ-BTP showed sensitivity and specificity of 69 and 86%, respectively. Conclusions The IQ-BTP extensive formal validation showed satisfactory psychometric and validity properties. Its content, face, construct, and criterion validities and its reliability, interpretability, and responsiveness were shown. Its use enabled potential-BTcP to be identified and differentiated into three likelihood classes with direct therapeutic and epidemiological implications. The latter may be confirmed in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00274-9.

Background: La mucosite orale è una manifestazione che affligge tra il 40 e il 70% dei pazienti sottoposti a chemio- o radio-terapia. Il sintomo soggettivo cardine è il dolore, moderato/severo, che compromette sia la fonazione che la nutrizione. Inoltre, le ulcerazioni, sono a rischio di infezioni secondarie. Oltre all’impatto sulla qualità di vita, la mucosite può prolungare la degenza ed aumentare la morbilità del trattamento in corso. In letteratura sono riportati protocolli scarsamente conclusivi per la prevenzione e il trattamento della mucosite. Il trattamento antalgico comprende agenti ad uso topico e/o sistemico (FANS e/o Oppiodi, ad infusione continua o PCA, e agenti adiuvanti (Cortisonici e antidepressivi). Caso clinico: femmina, 23 anni, con linfoma di Hodjkin varietà sarcomatosa Bulky mediastino. Dopo diversi cicli di chemioterapia senza esito positivo è stata sottoposta al trapianto allogenico da sorella HLA compatibile e immunosoppressione. In seguito compaiono: nausea, vomito e dolore al cavo orale. Vengono prescritti dosi crescenti di fentanile transdermico fino a 75 mcg/ora, e Morfina 3 -10 mg e.v. al bisogno. La mucosite (4° grado) e il dolore si aggravano e il dosaggio della Morfina viene aumentato fino a 90 mg/die. Il caso viene segnalato al servizio di terapia antalgica. Al momento della visita antalgica si rileva: SVSs=4, SVSd=5, VASs=7, VASd=8. Si programma una graduale sospensione della Morfina, per un episodio di depressione respiratoria e si prescrive Prednisone 0.5-1 mg/kg e.v. e Amitriptilina 4% a dosaggi crescenti (fino a 50 mg die). Nei giorni seguenti si constata un netto miglioramento sia del quadro obiettivo della mucosite che di quello soggettivo del dolore (SVSs=2, SVSd=3, VASs=3, VASd=5). Note conclusive: Il severo dolore che accompagna la mucosite post chemioterapia ha ricevuto scarsa attenzione in letteratura. La programmazione di un protocollo mirato per limitare la sua manifestazione e a ridurre il dolore che l’accompagna deve far parte integrale della che mio e radio-terapia. IL Prednisone 0.5-1 mg/kg e.v. può rappresentare un fulcro di un siffatto protocollo. 1. Epstein J.B. and Schubert M.M. Managing pain in mucositis Seminars in Oncology Nursing, Vol 20, No 1 (February), 2004: pp 30-37 2. Eilers J. and Epstein J.B. Assessment and measurement of oral mucositis Seminars in Oncology Nursing, Vol 20, No 1 (February), 2004: pp 22-29

Pain prevalence among inpatients is an important indicator of quality care; it may reach over 80% in various clinical settings. A cross-sectional survey was conducted in a teaching hospital to depict benchmark data regarding pain prevalence and predictors among the entire inpatient population. Overall 892 patients, 6 years old and hospitalized for at least 24 h in 57 hospital wards were interviewed using an internationally applied questionnaire. Patients self-reported their pain intensity at the time of the interview (T(0)) and worst pain perceived during the previous 24 h (T(-1)), using a numerical rating scale (NRS) and indicated current pain duration. Specific pain predictor data (hospital stay, gender, age and marital status) were obtained from patient medical charts. Pain prevalence at T(0) was 38% and 52% at T(-1). Pain was moderate to severe (NRS4) in approximately 25% of the patients at T(0) and in 40% at T(-1). High pain prevalence was found (at T(0) and T(-1), respectively) in Radiotherapy (63%;77%), Obstetrics (68%;54%), and Surgery (59%;45%) wards. Gender was a prominent determinant as pain was significantly associated with females. Pain prevalence was high among young adults or divorced/separated individuals and low among pediatric patients ( approximately 20%). Protracted hospitalization and prolonged pain duration were associated with major pain severity. Results yield Quality Assurance interventions to ameliorate pain undertreatment. Predictor analysis suggests that attention should be paid to pain management in young adults, socially vulnerable patients and those with protracted hospitalization and pain.

In macaque monkeys, corticocortical connections between distinct parietotemporal visual areas (areas MST-FST, DP, and 7a) and frontal periarcuate areas are studied using tritiated aminoacids and WGA-HRP. While labeling within the banks of the principal sulcus, the dorsal part of the arcuate concavity, and the banks of the upper arcuate limb were present in both 7a and MST-FST injected animals; in the latter cases, additional projections were found towards frontal regions including the dorsomedial frontal cortex and the posterior bank of the arcuate ventral limb. Our results point to widespread frontal connections of the MST-FST complex, involving both prefrontal and premotor cortical regions.