Breakthrough pain is a common problem in patients with cancer. The prevalence of breakthrough pain has been reported to be 19-95% amongst various groups of patients [1]. This disparity reflects a number of factors, including differences in the definition used, in the methods used, and in the populations studied [2].

Many authors have adopted the diagnostic criteria for breakthrough pain employed by Portenoy & Hagen (i.e. controlled background pain, stable analgesic regimen) [3]. Table 1 shows the prevalence of breakthrough pain in English-language studies applying these diagnostic criteria for breakthrough pain [3-10].

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BTCP = breakthrough cancer pain
Table 1 – Prevalence of breakthrough pain in studies applying standard criteria for breakthrough pain (adapted from reference 14).

An International Association for the Study of Pain (IASP) survey of cancer pain characteristics and syndromes found that pain specialists from English-speaking (North America, Australasia) and Northern / Western European countries reported more breakthrough pain than pain specialists from South American, Asian and Southern / Eastern European countries [11,12].

Breakthrough pain appears to be more common in patients with advanced disease [13], in patients with poor performance status [12], in patients with pain originating from the vertebral column (and to a lesser extent other weight-bearing bones / joints) [12], and in patients with pain originating from the nerve plexuses (and to a lesser extent nerve roots) [12].

References

[1]. Zeppetella G, Ribeiro MD. Pharmacotherapy of cancer-related episodic pain. Expert Opinion on Pharmacotherapy 2003; 4(4): 493-502.

[2]. Mercadante S, Radbruch L, Caraceni A et al. Episodic (breakthrough) pain. Consensus conference of an Expert Working Group of the European Association for Palliative Care. Cancer 2002; 94(3): 832-9.

[3]. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain 1990; 41(3): 273-81.

[4]. Fine PG, Busch MA. Characterization of breakthrough pain by hospice patients and their caregivers. Journal of Pain and Symptom Management 1998; 16(3): 179-83.

[5]. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999; 81(1-2): 129-34.

[6]. Zeppetella G, O’Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. Journal of Pain and Symptom Management 2000; 20(2): 87-92.

[7]. Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain.  Journal of Pain 2002; 3(1): 38-44.

[8]. Gómez-Batiste X, Madrid F, Moreno F et al. Breakthrough cancer pain: prevalence and characteristics in patients in Catalonia, Spain. Journal of Pain and Symptom Management 2002; 24(1): 45-52.

[9]. Fortner BV, Demarco G, Irving G et al. Description and predictors of direct and indirect costs of pain reported by cancer patients. Journal of Pain and Symptom Management 2003; 25(1): 9-18.

[10]. Hwang SS, Chang VT, Kasimis B. Cancer breakthrough pain characteristics and responses to treatment at a VA medical center. Pain 2003; 101(1-2): 55-64.

[11]. Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. Pain 1999; 82(3): 263-74.

[12]. Caraceni A, Martini C, Zecca E et al. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliative Medicine 2004; 18(3): 177-83.

[13]. Colleau SM. The significance of breakthrough pain in cancer. Cancer Pain Release 1999; 12(4): 1-4.

[14]. Davies A. Introduction. In: Davies A, editor. Cancer-related breakthrough pain. Oxford: Oxford University Press; 2006. p. 1-11.