Breakthrough pain is a significant cause of morbidity in patients with cancer. Furthermore, breakthrough pain is associated with a number of troublesome physical, psychological and social complications (which themselves are a significant cause of morbidity in this group of patients) [1].

Breakthrough pain is associated with increased use of healthcare services (i.e. increased outpatient visits, increased inpatient admissions) [2], which results in higher levels of direct expenditure (e.g. prescription costs), and higher levels of indirect expenditure (e.g. transportation costs), for both the health service and the patient and their carers [3]. Breakthrough pain is also associated with increased use of social services. Breakthrough pain may impact on the patient’s ability to work / earn money, and potentially also the carer’s ability to work / earn money. There are also wider societal costs, some of which are  in terms of loss of productivity [4],

It is important that the cost of undertaking an intervention is weighed against the total cost of not undertaking the intervention (i.e. the total cost of not treating the breakthrough pain). For example, the use of oral transmucosal fentanyl has been reported to result in reduced use of certain healthcare services (i.e. inpatient admissions) [5], and increased ability to work / earn money (non-malignant pain) [6].

References

[1]. Skinner C, Thompson E, Davies A. Clinical features. In: Davies A, editor. Cancer-related breakthrough pain. Oxford: Oxford University Press; 2006. p. 13-22.

[2]. 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.

[3]. Fortner BV, Demarco G, Irving G, Ashley J, Keppler G, Chavez J, 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.

[4]. Abernethy AP, Wheeler JL, Fortner BV. A health economic model of breakthrough pain. American Journal of Managed Care 2008; 14(5): S129-40.

[5]. Burton AW, Driver LC, Mendoza TR, Syed G. Oral transmucosal fentanyl citrate in the outpatient management of severe cancer pain crises: a retrospective case series. Clinical Journal of Pain 2004; 20: 195-7.

[6]. Taylor DR, Webster LR, Chun SY et al. Impact of breakthrough pain on quality of life in patients with chronic, non-cancer pain: patient perceptions and effect of treatment with oral transmucosal fentanyl citrate (OTCF, Actiq). Pain Medicine 2007; 8: 281-8.