The management of cancer-related breakthrough pain

Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland

Clinical features of breakthrough pain

  • Breakthrough pain is not a single entity, it may be related to a number of different causes (cancer-related, treatment-related, concomitant illness) and different pathophysiologies (nociceptive, neuropathic, mixed)
  • Breakthrough pain is usually classified into one of two categories:
    • spontaneous pain (‘idiopathic pain’)—the episodes are not related to an identifiable precipitant, and so are unpredictable in nature
    • incident pain (‘precipitated pain’)—the episodes are related to an identifiable precipitant, and so are somewhat predictable in nature. Incident pain is usually sub-classified into one of three categories:
      • volitional incident pain—is brought on by a voluntary act (e.g. walking)
      • non-volitional incident pain—is brought on by an involuntary act (e.g. coughing)
      • procedural pain—is related to a therapeutic intervention (e.g. wound dressing)
  • Clinical features of breakthrough pain vary from individual to individual, and may vary within an individual over time. Breakthrough pain is often reported to be frequent in occurrence, acute in onset, short in duration, and moderate-to-severe in intensity

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