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BREAKTHROUGH CANCER PAIN (BTcP)

Introduction

Chronic pain, or background pain, is a common symptom for patients with cancer.1

The neurophysiology of this kind of pain is complex and, consequently, management involves treatments and palliations, including radiotherapy, chemotherapy, hormones, bisphosphonates and surgery. These, combined with pharmacological and non-pharmacological methods of pain control, optimise pain relief.2

The mainstay of pharmacological cancer pain management are opioids,2 with guidelines recommending background pain should be treated with an around-the-clock opioid dose.3

If a patient is suffering from transient exacerbations of pain, the first action should be to assess whether their background pain is adequately controlled.4

Breakthrough (cancer) pain is defined by the Association of Palliative Medicine as 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.5

The characteristics of BTcP are shown below:

Triggers for BTcP

BTcP is a common problem in cancer patients, as a direct or indirect result of the cancer itself, or the cancer treatment. The types and triggers of BTcP are as follows:

Predictable - Incident Related10

  • Voluntary - triggered by movement such as walking
  • Involuntary - triggered by reflex movement such as coughing
  • Procedural - related to therapeutic intervention such as wound dressing

Unpredictable - Spontaneous, Unrelated to Any Identifiable Action10

For advice on the responsible use of opioids to treat pain, including other types of pain, please click here

Average:

  • References

    1. Portenoy RK, et al. Prim Care & Cancer. 1991;April:27-33.

    2. The British Pain Society. Cancer Pain Management. 2010;1:1-116. Available from: https://www.britishpainsociety.org/static/uploads/resources/files/book_cancer_pain.pdf Accessed March 2023.

    3. Bennett D, et al. Pharmacol Ther. 2005;30:354-361.

    4. Davies AN, et al. Eur J Pain. 2009;13:331-338.

    5. Davies AN, et al. BMJ Support Palliat Care. 2018;8(3):241-249.

    6. Portenoy RK, et al. Pain. 1999;81:129-134.

    7. Portenoy RK. Pain. 1990;41:273-281.

    8. Simmonds MA. Oncology. 1999;13(8):1-9.

    9. Überall MA, et al. Curr Med Res Opin. 2011;27(7):1385-1394.

    10. Davies A (Ed.) Cancer-related breakthrough pain (2nd edition). Oxford: Oxford University Press 2012.

    KKI/UK/ABS/0012 November 2023