Drugs & Aging

, Volume 31, Issue 6, pp 405–411 | Cite as

Breakthrough Pain in Elderly Patients with Cancer: Treatment Options

  • Sophie Pautex
  • Nicole Vogt-Ferrier
  • Gilbert B. Zulian
Therapy in Practice


The prevalence of pain is high in the elderly and increases with the occurrence of cancer. Pain treatment is challenging because of age-related factors such as co-morbidities, and over half of the patients with cancer pain experience transient exacerbation of pain that is known as breakthrough pain (BTP). As with background pain, BTP should be properly assessed before being treated. The first step to be taken is optimizing around-the-clock analgesia with expert titration of the painkiller. Rescue medication should then be provided as per the requested need, while at the same time preventing identified potential precipitating factors. In the elderly, starting treatment with a lower dose of analgesics may be justified because of age-related physiological changes such as decreased hepatic and renal function. Whenever possible, oral medication should be provided prior to a painful maneuver. In the case of unpredictable BTP, immediate rescue medication is mandatory and the subcutaneous route is preferred unless patient-controlled analgesia via continuous drug infusion is available. Recently, transmucosal preparations have appeared in the medical armamentarium but it is not yet known whether they represent a truly efficient alternative, although their rapid onset of activity is already well recognized. Adjuvant analgesics, topical analgesics, anesthetic techniques and interventional techniques are all valid methods to help in the difficult management of pain and BTP in elderly patients with cancer. However, none has reached a satisfying scientific level of evidence as to nowadays make the development of undisputed best practice guidelines possible. Further research is therefore on the agenda.


Pregabalin Cancer Pain Rescue Medication Breakthrough Pain Oral Transmucosal Fentanyl Citrate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this article. Sophie Pautex, Nicole Vogt-Ferrier and Gilbert B. Zulian have no conflict of interests to report.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Sophie Pautex
    • 1
  • Nicole Vogt-Ferrier
    • 2
  • Gilbert B. Zulian
    • 3
    • 4
  1. 1.Community Palliative Care Unit, Division of Primary Care, Department of Community Medicine and Primary CareGeneva University HospitalsGenevaSwitzerland
  2. 2.Gerontopharmacology Unit, Division of Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive CareGeneva University HospitalsGenevaSwitzerland
  3. 3.Division of Palliative Medicine, Department of Readaptation and Palliative MedicineGeneva University HospitalsGenevaSwitzerland
  4. 4.Division of Palliative Medicine, Hôpital de Bellerive, DRMPHUGCollonge-BelleriveSwitzerland

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