Skip to main content
SpringerLink
Log in

Breakthrough Pain in Patients Referred to Pain Clinics: The Italian Pain Network Retrospective Study

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Despite breakthrough pain (BTP) being one of the most severe forms of pain, there are no definitive data on its prevalence.

Methods

The authors performed a retrospective survey of the prevalence of BTP in consecutive patients in four Italian pain clinics, subsequent to application of an Italian law mandating detailed clinical records on pain characteristics, treatment, and results. Mean pain intensity was assessed with a numerical rating scale from 0 to 10.

Results

The authors analyzed records of 1,401 patients (58% women, 33.1% patients with cancer). Transient episodes of severe pain or BTP were referred by 790 patients (56.4%), including 58.2% of the men (342 of 588) and 55.1% of the women (448 of 813). Among the 464 patients with cancer, 70.3% reported daily exacerbation of pain. The mean BTP intensity was 8.31 ± 1.58 and 31.1% of patients reported experiencing three episodes per day.

Conclusion

Despite some limitations of the study, the authors show that transient episodes of severe pain or BTP are significantly present both in cancer and other diseases, and that many patients are not yet receiving appropriate opioid therapy. The authors need validated tools at international level for the diagnosis and treatment of BTP in patients with cancer and for transitory and patients with severe non-cancer pain. A survey at national level is needed to estimate the prevalence of BTP in different settings, to plan specific medical education.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Portenoy RK, Hagen NA. Breakthrough pain: definition and management. Oncology (Williston Park). 1989;3(Suppl.): 25–29.

    CAS  Google Scholar 

  2. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41:273–281.

    Article  PubMed  CAS  Google Scholar 

  3. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81:129–134.

    Article  PubMed  CAS  Google Scholar 

  4. Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain. 2010;149:476–482.

    Article  PubMed  Google Scholar 

  5. Svendsen KB, Andersen S, Arnason S, et al. Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain. 2005;9:195–206.

    Article  PubMed  Google Scholar 

  6. Mercadante S, Radbruch L, Caraceni A, et al.; Steering Committee of the European Association for Palliative Care (EAPC) Research Network. Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer. 2002;94:832–839.

    Article  PubMed  Google Scholar 

  7. Zeppetella G. Impact and management of breakthrough pain in cancer. Curr Opin Support Palliat Care. 2009;3:1–6.

    Article  PubMed  Google Scholar 

  8. Caraceni A, Martini C, Zecca E, et al. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med. 2004;18:177–183.

    Article  PubMed  Google Scholar 

  9. Mercadante S, Costanzo BV, Fusco F, et al. Breakthrough pain in advanced cancer patients followed at home: a longitudinal study. J Pain Symptom Manage. 2009;38:554–560.

    Article  PubMed  Google Scholar 

  10. Mercadante S, Zagonel V, Breda E, et al. Breakthrough pain in oncology: a longitudinal study. J Pain Symptom Manage. 2010;40:183–190.

    Article  PubMed  Google Scholar 

  11. Greco MT, Corli O, Montanari M, et al.; Writing Protocol Committee; Cancer Pain Outcome Research Study Group (CPOR SG) Investigators. Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients: results from the Cancer Pain Outcome Research Study Group. Clin J Pain. 2011;27:9–18.

    Article  PubMed  Google Scholar 

  12. Mercadante S, Villari P, Casuccio A. An Italian survey on the attitudes in treating breakthrough cancer pain in hospice. Support Care Cancer. 2011;19:979–983.

    Article  PubMed  Google Scholar 

  13. Zeppetella G, O’Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice. Palliat Med. 2001;15:243–246.

    Article  PubMed  CAS  Google Scholar 

  14. Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA. Breakthrough pain in community-dwelling patients with cancer pain and non cancer pain, part 1: prevalence and characteristics. J Opioid Manag. 2010;6:97–108.

    Article  PubMed  Google Scholar 

  15. Haanpää M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152:14–27.

    Article  PubMed  Google Scholar 

  16. Andersson DA, Gentry C, Alenmyr L, et al. TRPA1 mediates spinal antinociception induced by acetaminophen and the cannabinoid Δ(9)-tetrahydrocannabiorcol. Nat Commun. 2011;22,:551.

    Article  Google Scholar 

  17. Caraceni A, Hanks G, Kaasa S, et al.; European Palliative Care Research Collaborative (EPCRC); European Association for Palliative Care (EAPC). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13:e58–e68.

    Article  PubMed  CAS  Google Scholar 

  18. Mercadante S. Pharmacotherapy for breakthrough cancer pain. Drugs. 2012;72:181–190.

    Article  PubMed  CAS  Google Scholar 

  19. Fisher A, Watling M, Smith A, Knight A. Pharmacokinetic comparisons of three nasal fentanyl formulations; pectin, chitosan and chitosan-poloxamer 188. Int J Clin Pharmacol Ther. 2010;48:138–145.

    PubMed  CAS  Google Scholar 

  20. Christrup LL, Foster D, Popper LD, Troen T, Upton R. Pharmacokinetics, efficacy, and tolerability of fentanyl following intranasal versus intravenous administration in adults undergoing third-molar extraction: a randomized, double-blind, double-dummy, two-way, crossover study. Clin Ther. 2008;30:469–481.

    Article  PubMed  CAS  Google Scholar 

  21. Lennernäs B, Hedner T, Holmberg M, et al. Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: a new approach to treatment of incident pain. Br J Clin Pharmacol. 2005;59:249–253.

    Article  PubMed  Google Scholar 

  22. Darwish M, Kirby M, Robertson P Jr, Hellriegel E, Jiang JG. Comparison of equivalent doses of fentanyl buccal tablets and arteriovenous differences in fentanyl pharmacokinetics. Clin Pharmacokinet. 2006;45:843–850.

    Article  PubMed  CAS  Google Scholar 

  23. Watts P, Smith A. PecSys: in situ gelling system for optimised nasal drug delivery. Expert Opin Drug Deliv. 2009;6:543–552.

    Article  PubMed  CAS  Google Scholar 

  24. Davies A, Sitte T, Elsner F, et al. Consistency of efficacy, patient acceptability, and nasal tolerability of fentanyl pectin nasal spray compared with immediate-release morphine sulfate in breakthrough cancer pain. J Pain Symptom Manage. 2011;41:358–366.

    Article  PubMed  CAS  Google Scholar 

  25. Portenoy RK, Burton AW, Gabrail N, Taylor D; Fentanyl Pectin Nasal Spray 043 Study Group. A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain. 2010;151:617–624.

    Article  PubMed  CAS  Google Scholar 

  26. Radbruch L, Torres LM, Ellershaw JE, et al. Long-term tolerability, efficacy and acceptability of fentanyl pectin nasal spray for breakthrough cancer pain. Support Care Cancer. 2012;20:565–573.

    Article  PubMed  Google Scholar 

  27. Taylor D, Galan V, Weinstein SM, et al.; Fentanyl Pectin Nasal Spray 043 Study Group. Fentanyl pectin nasal spray in breakthrough cancer pain. J Support Oncol. 2010;8:184–190.

    PubMed  Google Scholar 

  28. Mercadante S. Managing breakthrough pain. Curr Pain Headache Rep. 2011;15:244–249.

    Article  PubMed  Google Scholar 

  29. Mercadante S, Gatti A, Porzio G, et al. Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses. Curr Med Res Opin. 2012. Epub ahead of print.

  30. Sabato AF. Idiopathic breakthrough pain. A new hypothesis. Clin Drug Investig. 2010;30:27–29.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Care, Critical Care Medicine, Pain Medicine and Anesthesiology Department, Tor Vergata Polyclinic, University of Rome Tor Vergata, Rome, Italy

    Antonio Gatti & Alessandro Fabrizio Sabato

  2. Palliative Care and Pain Therapy, Careggi University Hospital, Florence, Italy

    Rocco D. Mediati & Renato Vellucci

  3. Anesthesiology, Resuscitation, and Pain Therapy Department, University of Rome La Sapienza, Rome, Italy

    Carlo Reale, Alessandro Canneti & Marta Luzi

  4. National Canc er Institute, IRCCS Foundation Pascale, Naples, Italy

    Arturo Cuomo & Gennaro Russo

  5. Pain Therapy and Palliative Care Unit, Department of Anesthesiology, University of Chieti-Pescara, Chieti, Italy

    Amedeo Costantini

  6. Primary Care, Regional Health System, via Aurelia 784, Rome, Italy

    Massimo Mammucari

Authors
  1. Antonio Gatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rocco D. Mediati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Reale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arturo Cuomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Renato Vellucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gennaro Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amedeo Costantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alessandro Canneti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marta Luzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Massimo Mammucari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alessandro Fabrizio Sabato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Mammucari.

Additional information

To view enhanced content go to www.advancesintherapy.com

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gatti, A., Mediati, R.D., Reale, C. et al. Breakthrough Pain in Patients Referred to Pain Clinics: The Italian Pain Network Retrospective Study. Adv Therapy 29, 464–472 (2012). https://doi.org/10.1007/s12325-012-0022-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-012-0022-z

Keywords

Search

Navigation