Guidelines for the Management of Breakthrough Pain in Patients With Cancer

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  • a From Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; European Palliative Care Research Center (PRC), Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Palliative Medicine, St. Luke’s Cancer Centre, Guildford, Surrey, United Kingdom; Palliative Care Unit, Polyclinique de l’Ormeau, Tarbes, France; Medical Oncology Department, Hopital Univ 12 Octubre, Madrid, Spain; National Institute of Pain, Lutz, Florida, USA; and Anaesthesiology Department, University of Parma, Parma, Italy; Pain and Palliative Care Board to Ministry of Health.
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The moral imperative to adequately manage pain is being increasingly recognized worldwide. A comprehensive pain management approach that addresses the various presentations of pain in patients with cancer is required, including appropriate management of breakthrough pain. Breakthrough pain commonly occurs in patients with advanced cancer and is disabling to the individual and burdensome to society, yet it is often inadequately managed. Because pain is heterogeneous, the best management of an individual’s pain, including breakthrough pain in cancer, requires a thorough assessment to tailor the treatment strategies. Recently developed guidelines support this approach and recommend treating breakthrough pain using rapid- or short-acting opioids with pharmacodynamics that mirror the rapid onset and short duration of the presenting pain. This approach should be part of a comprehensive strategy to treat pain within the context of the primary disease trajectory, offering continuity of care and access to specialized palliative care when appropriate.

Correspondence: Augusto Caraceni, MD, via Venezian 1, Milan, Italy 20133. E-mail: augusto.caraceni@istitutotumori.mi.it

Dr. Caraceni is a consultant for Archimedes Pharma; is on the speakers’ bureaus of Grünenthal-Formenti, Molteni Farmaceutici, Mundipharma, and Pfizer; and has received grant/research support from Cephalon, Grünenthal-Formenti, Mundipharma, Novartis, and Pfizer. Dr. Davies is a consultant for Archimedes, Cephalon, Meda Pharmaceuticals, Nycomed, and ProStrakan; is on the speakers’ bureaus of Archimedes Pharma, Cephalon, Nycomed, and ProStrakan; and has received grant/research support from Cephalon, Nycomed, and ProStrakan. Dr. Poulain is on the speakers’ bureaus of Archimedes Pharma, Cephalon-Teva, Nycomed-Takeda Pharmaceuticals International, and Janssen Pharmaceuticals, Inc. Dr. Cortés-Funes has served as a consultant at an advisory board meeting on breakthrough pain for Archimedes. Dr. Panchal has served as a consultant for Johnson & Johnson, Endo Pharmaceuticals, DepoMed, and Archimedes. Dr. Fanelli reports no conflicts of interest; he served as a consultant at an advisory board meeting on breakthrough pain for Archimedes.

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