Treatment strategies for cancer patients with breakthrough pain

Alessandra Casuccio*a, Sebastiano Mercadantebc & Fabio Fulfaroda University of Palermo, Department of Clinical Neuroscience, Via Liborio Giuffrè 13, 90127 Palermo, Italy +39 091 6553929; +39 091 6553930; b Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italyc University of Palermo, Intensive Care and Emergency, Palliative Medicine Teaching, Palermo, Italyd University of Palermo, Operative Unit of Medical Oncology, Department of Oncology, Palermo, Italy† Author for correspondenceBackground: Breakthrough pain (BTP) is a transitory flare of pain superimposed on an otherwise stable pain pattern in patients treated with opioids. It is normally severe in intensity, has a rapid onset, has a variable duration (on average 30 min) and is considered a negative prognostic factor. Objective: To verify the data in the literature about therapy strategies for BTP in cancer patients. Methods: To find clinical trials investigating drug therapy for BTP. Conclusion: The treatment of BTP in cancer patients receiving opioids is principally based on the use of opioids, preferentially with a short onset. Fentanyl delivered by recently developed systems seems to be the best option to cover the temporal pattern of BTP, although the treatment should be highly personalized to provide the best in individuals, balancing patients' preferences and clinical needs. The doses to be administered is still a matter of controversy in the literature; additional studies with specific designs should be conducted to settle the question.