Breakthrough Cancer Pain BTcP: a Synthesis of Taxonomy, Pathogenesis, Therapy, and Good Clinical Practice in Adult Patients in ItalyReportar como inadecuado

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Advances in Therapy

, Volume 31, Issue 7, pp 657–682

First Online: 09 July 2014Received: 27 March 2014DOI: 10.1007-s12325-014-0130-z

Cite this article as: Zucco, F., Bonezzi, C. & Fornasari, D. Adv Ther 2014 31: 657. doi:10.1007-s12325-014-0130-z


Pain presents in 80% of patients with advanced cancer, and 30% have periods of increased pain due to fluctuating intensity, known as breakthrough cancer pain BTcP. BTcP is high-intensity, short-duration pain occurring in several episodes per day and is non-responsive to treatment. The clinical approach to BTcP is variable. A review of the literature was performed to provide clinicians and practitioners with a rational synthesis of the ongoing scientific debate on BTcP and to provide a basis for optimal clinical approach to BTcP in adult Italian patients. Data show that circadian exacerbations of pain should be carefully monitored, differentiating, if possible, between fluctuations of background pain BP, end-of-dose effect, and BTcP. BTcP should be monitored in all care contexts in clinical practice and each care facility must have all the medications and products approved for use in BTcP at their disposal. Data show that knowledge about medications for BTcP is lacking: medications for BTcP treatment are not interchangeable, although containing the same active substance; each physician must know the specific characteristics of each medication, its pharmacological properties, limitations in clinical practice, specifics relating to titration and repeatability of administration, and technical specifics relating to the accessibility and delivery. Importantly, before choosing a rapid-onset opioid ROO, it is essential to deeply understand the status of patient and the characteristics of their family unit-caregivers, taking into account the patient’s progressive loss of autonomy and-or cognitive-relational functionality. When BTcP therapy is initiated or changed, special attention must be paid to training the patient and family members-caregivers, providing clear instructions regarding the timing of drug administration. The patient must already be treated effectively with opioids before introducing ROOs for control of BTcP.

KeywordsBreakthrough cancer pain BTcP Cancer Fentanyl Pain Pain exacerbation Palliative care Electronic supplementary materialThe online version of this article doi:10.1007-s12325-014-0130-z contains supplementary material, which is available to authorized users.

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Autor: Furio Zucco - Cesare Bonezzi - Diego Fornasari


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