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http://dx.doi.org/10.14475/kjhpc.2015.18.1.1

Breakthrough Cancer Pain  

Seo, Min Seok (Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital)
Shim, Jae Yong (Yonsei University Graduate School of Medicine)
Publication Information
Journal of Hospice and Palliative Care / v.18, no.1, 2015 , pp. 1-8 More about this Journal
Abstract
Breakthrough cancer pain is a transient exacerbation of pain that occurs despite relatively well controlled background pain with around-the-clock analgesia. It is highly prevalent in patients with cancer pain, with an overall prevalence of 70~90%. Breakthrough cancer pain has several negative effects on quality of life, including a decrease in functional status and social relationship, and higher incidence of anxiety/depression. It also places a detrimental burden on their families, society, and the healthcare system. According to the pathogenic mechanism, breakthrough cancer pain is classified into two categories: idiopathic (or spontaneous) pain and incident pain. Episodes of breakthrough cancer pain have typical characteristics, including rapid onset (5~10 min), severe intensity, and short duration (30~60 min). However, there are some variations in timing and severity of pain among patients and episodes. Therefore, a thorough assessment of pain episodes is needed and management plan must be individualized to provide optimal treatment. Several immediate-release formulations such as oxycodone, morphine, and hydromorphone are widely used despite relatively slow onset of action. Recent studies have shown that transmucosal fentanyl preparations were effective for faster control of breakthrough pain. We hope to improve management of breakthrough cancer pain with more efficient analgesics in line with currently available evidence.
Keywords
Breakthrough pain; Neoplasms; Analgesics; Fentanyl;
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1 Foley KM. Acute and chronic cancer pain syndromes. In: Doyle D, Hanks G, Cherny N, Calman K, eds. Oxford textbook of palliative medicine. 3rd ed. New York:Oxford University Press; 2004. p. 298-316.
2 van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007;18:1437-49.   DOI
3 Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and pooled analysis of published literature. J Pain Symptom Manage 2014;47:57-76.   DOI
4 Hong SH, Roh SY, Kim SY, Shin SW, Kim CS, Choi JH, et al. Change in cancer pain management in Korea between 2001 and 2006: results of two nationwide surveys. J Pain Symptom Manage 2011;41:93-103.   DOI
5 Caraceni A, Martini C, Zecca E, Portenoy RK, Ashby MA, Hawson G, et al. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 2004;18:177-83.   DOI
6 Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain 2002;3:38-44.
7 Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 2010;149:476-82.   DOI
8 Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain 1990;41:273-81.   DOI
9 Walsh D, Rivera NI, Davis MP, Lagman R, Legrand SB. Strategies for pain management: cleveland clinic foundation guidelines for opioid dosing for cancer pain. Support Cancer Ther 2004;1: 157-64.   DOI
10 Zucco F, Bonezzi C, Fornasari D. Breakthrough cancer pain (BTcP): a synthesis of taxonomy, pathogenesis, therapy, and good clinical practice in adult patients in Italy. Adv Ther 2014;31:657-82.   DOI
11 Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA. Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manag 2010;6:97-108.   DOI
12 Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G; Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. 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 2009;13:331-8.   DOI
13 Corli C, Pizzuto M; OICP Research Group. Per qualche dolore in meno. Capire e trattare il breakthrough cancer pain. Roma: CIC Edizioni Internazionali;2011.
14 Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, et al. Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manage 2013;46:619-28.   DOI
15 Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson LE, Fisher K, et al. The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a delphi process and patient think-aloud interviews. J Pain Symptom Manage 2008; 35:136-52.   DOI
16 Sperlinga R, Campagna S, Berruti A, Laciura P, Ginosa I, Paoletti S, et al. Alberta Breakthrough Pain Assessment Tool: A validation multicentre study in cancer patients with breakthrough pain. Eur J Pain 2014 Nov 5. Epub 2014 Nov 5.
17 Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M, et al. An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 2010;46:2896-904.   DOI
18 Raj SX, Thronaes M, Brunelli C, Hjermstad MJ, Klepstad P, Kaasa S. A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer 2014;22:1965-71.   DOI
19 Caraceni A, Bertetto O, Labianca R, Maltoni M, Mercadante S, Varrassi G, et al. Episodic (breakthrough) pain prevalence in a population of cancer pain patients. Comparison of clinical diagnoses with the QUDEI--Italian questionnaire for intense episodic pain. J Pain Symptom Manage 2012;43:833-41.   DOI
20 Zeppetella G, Ribeiro MD. Episodic pain in patients with advanced cancer. Am J Hosp Palliat Care 2002;19:267-76.   DOI
21 Breakthrough cancer pain survey fact sheet [Internet]. Baltimore: American Pain Foundation (US); 2010. Apr 26 [cited 2015 Jan 2]. Available from: http://www.harrisinteractive.com/vault/Client_News_AmericanPainFoundation_Fact_2010_01.pdf.
22 Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 2009;20:1420-33.   DOI
23 Portenoy RK. Treatment of temporal variations in chronic cancer pain. Semin Oncol 1997;24(5 Suppl 16): S16-7-12.
24 Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012;13:e58-68.   DOI
25 Hanks G. Oral transmucosal fentanyl citrate for the management of breakthrough pain. Eur J Palliat Care 2001;8:6-9.
26 Zeppetella G, Davies AN. Opioids for the management of breakthrough pain in cancer patients. Cochrane Database Syst Rev 2013;10:CD004311.
27 Bedard G, Davies A, McDonald R, Hawley P, Buchanan A, Popovic M, et al. Breakthrough cancer pain: a comparison of surveys with European and Canadian patients. Support Care Cancer 2015;23:791-6.   DOI
28 Bennett D, Burton AW, Fishman S, Fortner B, McCarberg B. Consensus panel recommendations for the assessment and management of breakthrough pain: Part II - management. P&T 2005;30:354-61.
29 Davies AN. Breakthrough cancer pain. Curr Pain Headache Rep 2014;18:420.   DOI
30 Current state and improvement plan of cancer pain management: focused on opioid analgesics [Internet]. Seoul: National Evidence-based Healthcare Collaborating Agency; 2012. Dec 31 [cited 2015 Jan 8]. Available from: http://www.neca.re.kr/center/researcher/report_view.jsp?boardNo=GA&seq=71&q=6 26f6172644e6f3d4741.
31 Jandhyala R, Fullarton JR, Bennett MI. Efficacy of rapid-onset oral fentanyl formulations vs. oral morphine for cancer-related breakthrough pain: a meta-analysis of comparative trials. J Pain Symptom Manage 2013;46:573-80.   DOI
32 Bhatnagar S, Devi S, Vinod N, Jain P, Durgaprasad G, Maroo SH, et al. Safety and efficacy of oral transmucosal fentanyl citrate compared to morphine sulphate immediate release tablet in management of breakthrough cancer pain. Indian J Palliat Care 2014;20:182-7.   DOI
33 Darbà J, Kaskens L, Sanchez-de la Rosa R. Budget impact analysis of the fentanyl buccal tablet for treatment of breakthrough cancer pain. Clinicoecon Outcomes Res 2013;6:1-9.
34 Yamaguchi T, Shima Y, Morita T, Hosoya M, Matoba M; Japanese Society of Palliative Medicine. Clinical guideline for pharmacological management of cancer pain: the Japanese Society of Palliative Medicine recommendations. Jpn J Clin Oncol 2013;43:896-909.   DOI
35 Guidelines & protocols: palliative care for the patient with incurable cancer or advanced disease - Part 2: pain and symptom management [Internet]. Victoria, B.C.: British Columbia. Ministry of Health; 2011. Sep 30 [cited 2015 Jan 5]. Available from: http://www.bcguidelines.ca/guideline_ palliative2.html.
36 Poulain P, Michenot N, Ammar D, Delorme C, Delorme T, Diquet B, et al. Mise au point sur l'utilisation du fentanyl transmuqueux: chez le patient présentant des douleurs d'origine canc?reuse. Douleurs Analg 2012;25:102-17.   DOI
37 NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain Version 2. [Internet]. Washington, PA: National Comprehensive Cancer Network (US); 2014. May 11 [cited 2014 Dec 29]. Available from: http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf.