Breakthrough Pain in Oncology: A Longitudinal Study

Abstract

Context. Existing studies on breakthrough pain (BP) have reported different prevalence rates because of different settings, populations, and assessment methods. These studies have used cross-sectional designs, and the relationship of BP with analgesic treatment has not been evaluated.Objectives. The aim of this study was to longitudinally assess BP in cancer patients admitted to oncology units.Methods. A consecutive sample of patients admitted to oncology centers was selected. At admission (T0), three months after admission (T3), and six months after admission (T6), data on background pain and BP were recorded. BP was assessed in terms of its intensity, duration, number of episodes, onset with movement, spontaneous relief after stopping activity, limitation of physical activity, and effectiveness of analgesics.Results. Three hundred two patients completed the study. At T0, T3, and T6, 39%, 38%, and 33% patients, respectively, had continuous pain (P ¼ 0.294). Pain intensity significantly decreased (P ¼ 0.004 and 0.027 at T3 and T6, respectively). Most patients had BP at T0 (87.1%), T3 (80.9%), and T6 (73.2%), and there was a significant decrease in the prevalence of BP over time (P ¼ 0.016). Of 149 patients with BP, pain on movement was recorded in 43.6%, 43.4%, and 32.4% at T0, T3, and T6, respectively (P ¼ 0.228). Pain spontaneously decreased or ceased when stopping physical activity in 66%, 56%, and 62% at T0, T3, and T6, respectively (P ¼ 0.537). Pain on movement strongly limited physical activity in most patients. Conclusion. These data expand current information about BP and underline the need for a longitudinal assessment of a phenomenon that is invariably dependent on stage of disease, patient, and therapeutic factors. J Pain Symptom Manage 2010;40:183e190. Ó

Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

“…Breakthrough cancer pain (BTcP) has been variably reported in literature, ranging in 40-80% of cancer patients with pain, depending on the setting and the definition used to identify it [1][2][3][4] . The pioneer definition suggests that ''BTcP is a transitory increase in pain to greater than moderate intensity which occurs on a baseline pain of moderate intensity or less'' 5 .…”

Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group

“…BTcP has been variably reported in literature, ranging in 40-80 % of cancer patients with pain, depending on the setting and the definition used to identify it [1][2][3][4][5][6]. The pioneer definition suggests that BBTcP is a transitory increase in pain to greater than moderate intensity which occurs on baseline pain of moderate intensity or less^ [1].…”

“…This finding has been explained by the reduced physical activity, minimizing the incident component of pain induced by movement due to bone metastases. Another reason could rely on a more intensive pain management in the palliative care setting [5,6] Considering that all fentanyl products for BTcP are indicated only in patients tolerant to at least 60 mg of oral morphine equivalents, this limit could be utilized for a further screening of patients with BTcP. At the moment, there is no information about BTcP in patients receiving low doses of strong opioids (less than 60 mg/day of oral morphine equivalents) or opioids for mild-moderate pain (Table 1).…”

The pain, the oncologist

“…It has been established that the large variability depends on the setting, as well as the clinical and organizational issues. For instance, clear differences have been found between very advanced cancer patients followed at home and unselected patients recruited in an oncologic setting, like those observed in this study [6,7]. Thus, breakthrough pain should be considered as a dynamic entity dependent on several factors, including analgesic treatment, level of physical activity, and the course of disease [8].…”