Multi‐centre European study of breakthrough cancer pain: Pain characteristics and patient perceptions of current and potential management strategies

Abstract

This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number of episodes was 3/day. Forty-four percent patients reported incident-type pain, 39% spontaneous-type pain, and 17% a combination of these pains. The median duration was 60 min, and the median time to peak intensity was 15 min. Three percent patients reported "mild" pain, 37% "moderate" pain, and 60% "severe" pain. Ninety percent patients stated that the pain interfered with their daily activities. All patients were using opioids as rescue medication (mainly oral morphine/oxycodone), whilst 28% patients were using non-opioids, and 50% patients were using non-pharmacological interventions. Only 55% patients took rescue medication every time they experienced breakthrough pain. Sixty-five percent patients would definitely consider using an oral transmucosal product; patients from Denmark were less likely to answer positively, and a positive response was associated with previous use of the route for breakthrough pain. Seventy-three percent patients reported regular oral problems. Forty-two percent patients would definitely consider using an intranasal product, with 26% patients stating they would definitely not use such a preparation; patients from Denmark and Sweden were less likely to answer positively, and a positive response was associated with male gender, and previous use of the route. Forty-four percent patients reported regular nasal problems. Sixty percent patients would definitely consider using a subcutaneous product, and 44% patients would definitely consider using an intrapulmonary product.

The use of fentanyl buccal tablets for breakthrough pain by using doses proportional to opioid basal regimen in a home care setting

“…In addition, patients who had unstable background analgesia or more than four episodes of BTP/day were excluded. The criterion to define BTP was reported in previous studies [6,12,14,21]. From this sample, patients who were receiving opioids in doses of oral morphine equivalents equal or more than 60 mg daily were prescribed FBT in doses proportional to opioids used for background analgesia.…”

“…The availability of supplemental doses of opioids (rescue medication) in addition to the continuous analgesic medication is the main treatment suggested to manage these pain flares [10]. For years, anecdotal experience has suggested that the starting effective dose of BTP medication must be a percentage of a patient's total daily opioid dose [6]. As pain relief is usually required urgently in the last decade, new routes of administration have been designed to provide fast pain relief.…”

“…Finally, many patients may be reluctant to try the dose and avoid the use of these drugs, preferring, at the end, traditional oral dosing of morphine [4]. In a recent survey, most patients were using oral opioids, and only 55 % of patients took rescue medication every time they experienced BTP [6]. Thus, low doses of ROOs, started in an attempt to titrate the doses individually, could result in unnecessary suffering, lowering of clinical compliance, and refusal to continue the treatment, particularly in specific settings, such as palliative home care or outpatient clinics, where patients should try the doses with different attempts.…”

Canadian Recommendations for the Management of Breakthrough Cancer Pain

“…Although btcp can last up to 60 minutes, the typical duration of an episode is 15-30 minutes [3][4][5][6] . Another important distinguishing characteristic of btcp is its rapid onset, with escalation to maximum intensity in as little as 1 minute [3][4][5][6][7] . The frequency of the pain episodes can vary from a single time to several times daily or weekly 7,8 .…”

1512 A Korean nationwide survey for breakthrough cancer pain in an inpatient setting

“…BTcP differs from BCP due to its high intensity (numerical rating score [NRS], 7), the short time interval between onset and peak intensity (median interval, 3 minutes to peak pain), short duration (median, 30 to 60 minutes), potential recurrence over 24 hours (3-4 daily episodes), and non-responsiveness to treatments for BCP [3,[6][7][8][9].…”