Breakthrough cancer pain in 2020

Abstract

Purpose of the review: An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.Recent findings: The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases (ICD-11), the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.Summary: All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.

Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings

“…Breakthrough cancer pain (BTcP) is a heterogeneous construct whose definition is far from clearly established [ 1 ]. However, it is generally accepted that BTcP includes two main components, namely (i) the presence of controlled baseline oncological pain and (ii) a transient exacerbation of this pain [ 2 , 3 ].…”

“…Accordingly, BTcP was recently defined as a severe pain episode of short duration (usually less than 30 min) in patients who are receiving stable opioid-based analgesics for baseline pain, which is described as mild to moderate in intensity (i.e., under four points in a numerical rating scale from 0 to 10) [ 4 ]. According to its triggering factors, BTcP could be classified as incidental (predictable: provoked by voluntary movements such as walking; unpredictable: provoked by involuntary reactions such as swallowing or intestinal distension) or spontaneous (i.e., without a clear trigger) [ 1 , 2 ].…”

“…Not surprisingly, it was postulated that the assessment of BTcP is a key element in pain management in persons with cancer and should be incorporated in routine oncological care [ 4 ]. Thus, monitoring of patients with cancer should incorporate the evaluation of both baseline pain and BTcP episodes, including not only the presence/absence of BTcP but also the characteristics of the episodes [ 1 , 15 ]. This information (i.e., periodicity, duration, and intensity of BTcP episodes) could be especially relevant for clinicians who attend to people with pain complaints, as it may help guide care plans [ 4 ] and provide personalized treatments [ 16 ].…”

Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

“…Several pieces of evidence showed that BTcP cannot be intended as a single nosological entity but includes different and changing pathogenetic mechanisms justifying its sub-typing [7,9,17]. Consequently, methods useful for dissecting the NP-BTcP forms can offer great help for clinicians and important benefits for patients [18].…”

Prophylactic corticosteroid to prevent pain flare in bone metastases treated by radiotherapy

“…Bone pain due to metastases is the most common symptom demanding treatment in oncological patients [1]. Beside the pain, bone metastases (BM) can cause spinal cord compression, pathological fractures, and hypercalcemia [2].…”