A rapid systematic review of breakthrough pain definitions and descriptions

Abstract

Background: Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain.

Objective: This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts.

Design: This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583).

Data sources: CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022.

Results: We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients (n = 30), clinicians (n = 6), and experts (n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life.

Conclusions: Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.

Keywords: Breakthrough pain; pain classification; systematic review.

Figure 1.

Flow of records for inclusion in a rapid systematic review of the definition, description, and classification of breakthrough pain by patients, caregivers, clinicians, and experts.

Figure 2.

Schematic representation of the key terms found in a rapid systematic review of experts’, clinicians’, and patients’ definitions of breakthrough pain. Coloured boxes with bold outlines indicate the most commonly used terms. White boxes indicate descriptions used only by a minority in the literature. Boxes with dashed outlines signify suggestions from experts for terms to replace ‘breakthrough pain’.