Impact and management of breakthrough pain in cancer

Abstract

Purpose of review: To outline the impact of breakthrough pain, the evidence for the current management and new treatment options that are becoming available.

Recent findings: Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. Despite its self-limiting nature, breakthrough pain can place significant physical, psychological, and economic burdens on both patients and their carers. The successful management breakthrough pain may require a combination of pharmacological and nonpharmacological treatment strategies; supplemental analgesia, known as rescue medication, is a common pharmacological treatment option. The ideal rescue medication should have a rapid onset, good efficacy, relatively short duration of action, and minimal adverse effects and is best administered before or soon after breakthrough pain has started. Although oral opioids are commonly used, there is increasing evidence that transmucosal opioids may be more effective.

Summary: Breakthrough is a common heterogeneous pain state that can have a devastating impact on both patients and carers. Despite the growing literature on breakthrough pain, there are still many aspects yet to be addressed including an urgent need to standardize terminology, for carefully designed epidemiological studies and for well designed controlled trials comparing the different treatment options.