Skip to main content

What is Cancer Breakthrough Pain?

  • Chapter
  • First Online:
Book cover Managing Cancer Breakthrough Pain
  • 779 Accesses

Abstract

The original definition of cancer breakthrough pain (cBTP), given by Portenoy and Hagen [1], is the template upon which the majority of subsequent definitions have been based: breakthrough pain (BTP) is a transitory increase in pain to greater than moderate intensity on a baseline pain of moderate intensity or less.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Portenoy RK, Hagen NA. Breakthrough pain: definition and management. Oncology (Williston Park). 1989;3(8 Suppl):25-29.

    Google Scholar 

  • 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;13:331-338.

    Google Scholar 

  • Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain: Part 1 Assessment. P T. 2005;30:296-301.

    Google Scholar 

  • Turk DC, Okifuji A. Pain terms and taxonomies of pain. In: Fishman SM, Ballantyne JC, Rathmell JP, eds. Bonica’s Management of Pain. 4th ed. New York, NY: Lippincott Williams & Wilkins; 2010:13-23.

    Google Scholar 

  • Berger AM, Portenoy RK, Weissman DE. Preface. In: Berger A, Portenoy RK, Weissman DE, eds. Principles and Practice of Supportive Oncology. Lippincott Williams & Wilkins. Philadelphia, PA; 1998:xix-xx.

    Google Scholar 

  • Twycross RG. Where there is hope, there is life: a view from the hospice. In: Keown J, ed. Euthanasia Examined: Ethical, Clinical and Legal Perspectives. New York, NY: Cambridge University Press; 1995:141-168. 26 • Ma n ag i n g C a n c e r B r e a k t h r o u g h Pa i n.

    Google Scholar 

  • Mercadante S. Managing breakthrough pain. Curr Pain Headache Rep. 2011;15:244-249.

    Google Scholar 

  • 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;149:476-482.

    Google Scholar 

  • Zeppetella G. Breakthrough pain in cancer patients. Clin Oncol (R Coll Radiol). 2011; 23:393-398.

    Google Scholar 

  • Payne R. Recognition and diagnosis of breakthrough pain. Pain Med. 2007;8(8 Suppl 1):S3-S7.

    Google Scholar 

  • Zeppetella G. Impact and management of breakthrough pain in cancer. Curr Opin Support Palliat Care. 2009;3:1-6.

    Google Scholar 

  • Mercadante S, Radbruch L, Caraceni A, et al; Steering Committee of the European Association for Palliative Care (EAPC) Research Network. Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer. 2002;94:832-839.

    Google Scholar 

  • Bhatnagar S, Upadhyay S, Mishra S. Prevalence and characteristics of breakthrough pain in patients with head and neck cancer: a cross-sectional study. J Palliat Med. 2010;13:291-295.

    Google Scholar 

  • Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81:129-134.

    Google Scholar 

  • Kim DY, Song HS, Ahn JS, et al. The dosing frequency of sustained-release opioids and the prevalence of end-of-dose failure in cancer pain control: a Korean multicenter study. Supportive Care Cancer. 2011;19:297-301.

    Google Scholar 

  • Hall LM, O’Lenic K. Treatment strategies to overcome end-of-dose failure with oral and transdermal opioids. J Pharm Pract. 2011;25:503-509.

    Google Scholar 

  • Paice JA, Fine PG. Pain at the End of Life. In: Ferrell BR, Coyle N, eds. Oxford Textbook Of Palliative Nursing. 2nd ed. New York, NY: Oxford University Press, Inc.; 2006:131-155.

    Google Scholar 

  • Patt RB. Classification of cancer pain and cancer pain syndromes. In: Patt RB, ed. Cancer Pain. Philadelphia, PA: J.B. Lippincott Company; 1993:3-22.

    Google Scholar 

  • Caraceni A, Martini C, Zecca E, et al; Working Group of an IASP Task Force on Cancer Pain. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med. 2004;18:177-183.

    Google Scholar 

  • Caraceni A, Zecca E, Bonezzi C, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol. 2004; 22:2909-2917.

    Google Scholar 

  • Gatti A, Mediati RD, Reale C, et al. Breakthrough pain in patients referred to pain clinics: the Italian pain network retrospective study. Adv Ther. 2012;29:464-472.

    Google Scholar 

  • Caraceni A, Bertetto O, Labianca R, et al; Breakthrough/Episodic Pain Italian Study Group. 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;43:833-841.

    Google Scholar 

  • Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41:273-281.

    Google Scholar 

  • Davies A, Zeppetella G, Andersen S, et al. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain. 2011;15:756-763.

    Google Scholar 

  • Hagen NA, Stiles C, Nekolaichuk C, 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 Mange. 2008;35:136-152.

    Google Scholar 

  • National Cancer Institute. Pain (PDQR) Health Professional Version. www.cancer.gov/ cancertopics/pdq/supportivecare/pain/HealthProfessional/page1. Accessed February 1, 2013.

  • Wee B, Hillier R. Pain control. Medicine. 2008;36:67-71.

    Google Scholar 

  • Green CR, Montague L, Hart-Johnson TA. Consistent and breakthrough pain in diverse advanced cancer patients: a longitudinal examination. J Pain Symptom Manage. 2009; 37:831-847.

    Google Scholar 

  • Davies AN, Vriens J, Kennett A, McTaggart M. An observational study of oncology patients’ utilization of breakthrough pain medicine. J Pain Symptom Manage. 2008;35:406-411. Wh at i s c a n c e r b r e a k t h r o u g h pa i n? • 27.

    Google Scholar 

  • Christie JM, Simmonds M, Patt R, et al. Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain. J Clin Oncol. 1998;16:3238-3245.

    Google Scholar 

  • Actiq [package insert]. Frazer, PA: Cephalon, Inc; 2011.

    Google Scholar 

  • Hagen NA, Fisher K, Victorino C, Farrar JT. A titration strategy is needed to manage breakthrough cancer pain effectively: observations from data pooled from three clinical trials. J Palliat Med. 2007;10:47-55.

    Google Scholar 

  • Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain: Part 2 Management. P T. 2005; 30:354-361.

    Google Scholar 

  • Zeppetella G. Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage. 2008;35:563-567.

    Google Scholar 

  • Fitzgibbon D, Morgan D, Dockter D, Barry C, Kharasch ED. Initial pharmacokinetic, safety and efficacy evaluation of nasal morphine gluconate for breakthrough pain in cancer patients. Pain. 2003;106:309-315.

    Google Scholar 

  • Pavis H, Wilcock A, Edgecombe J, et al. Pilot study of nasal morphine-chitosan for the relief of breakthrough pain in patients with cancer. J Pain Symptom Manage. 2002;24:598-602.

    Google Scholar 

  • Fisher K, Stiles C, Hagen NA. Characterization of the early pharmacodynamic profile of oral methadone for cancer-related breakthrough pain: a pilot study. J Pain Symptom Manage. 2004;28:619-625.

    Google Scholar 

  • Jackson K, Ashby M, Keech, J. Pilot dose finding study of intranasal sufentanil for breakthrough and incident cancer-associated pain. J Pain Symptom Manage. 2002;23:450-452.

    Google Scholar 

  • Enting RH, Mucchiano C, Oldenmenger WH, et al. The “pain pen” for breakthrough cancer pain: a promising treatment. J Pain Symptom Manage. 2005;29:213-217.

    Google Scholar 

  • Mercadante S, Villari P, Ferrera P, Casuccio A. Optimization of opioid therapy for preventing incident pain associated with bone metastases. J Pain Symptom Manage. 2004;28:505-510.

    Google Scholar 

  • Zeppetella G, O’Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manage. 2000;20:87-92.

    Google Scholar 

  • Borgbjerg FM, Nielsen K, Franks J. Experimental pain stimulates respiration and attenuates morphine-induced respiratory depression: a controlled study in human volunteers. Pain. 1996;64:123-128.

    Google Scholar 

  • DuBose RA, Berde CB. Respiratory effects of opioids. IASP Newsletter. 1997;July/August:1-6.

    Google Scholar 

  • Fine PG, Narayana A, Passik SD. Treatment of breakthrough pain with fentanyl buccal tablet in opioid-tolerant patients with chronic pain: appropriate patient selection and management. Pain Med. 2010;11:1024-1036.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Donald Taylor .

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Healthcare

About this chapter

Cite this chapter

Taylor, D. (2013). What is Cancer Breakthrough Pain?. In: Managing Cancer Breakthrough Pain. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-908517-83-8_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-908517-83-8_2

  • Published:

  • Publisher Name: Springer Healthcare, Tarporley

  • Print ISBN: 978-1-908517-76-0

  • Online ISBN: 978-1-908517-83-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics