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Impact and management of breakthrough pain in cancer

Zeppetella, Giovambattista

Current Opinion in Supportive and Palliative Care: March 2009 - Volume 3 - Issue 1 - p 1–6
doi: 10.1097/SPC.0b013e3283260658
Pain: cancer: Edited by Sam H. Ahmedzai and Anthony H Dickenson

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.

St Clare Hospice, Hastingwood, Essex, UK

Correspondence to Dr Giovambattista Zeppetella, FRCP, Medical Director, St Clare Hospice, Hastingwood, Essex CM17 9JX, UK Tel: +44 1279 773775; fax: +44 1279 773771; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.