Treatment strategies for cancer patients with breakthrough pain.
BACKGROUND
Breakthrough pain (BTP) is a transitory flare of pain superimposed on an otherwise stable pain pattern in patients treated with opioids. It is normally severe in intensity, has a rapid onset, has a variable duration (on average 30 min) and is considered a negative prognostic factor.


OBJECTIVE
To verify the data in the literature about therapy strategies for BTP in cancer patients.


METHODS
To find clinical trials investigating drug therapy for BTP.


CONCLUSIONS
The treatment of BTP in cancer patients receiving opioids is principally based on the use of opioids, preferentially with a short onset. Fentanyl delivered by recently developed systems seems to be the best option to cover the temporal pattern of BTP, although the treatment should be highly personalized to provide the best in individuals, balancing patients' preferences and clinical needs. The doses to be administered is still a matter of controversy in the literature; additional studies with specific designs should be conducted to settle the question.
Casuccio
Alessandra
A
University of Palermo, Department of Clinical Neuroscience, Palermo, Italy. casuccio@unipa.it
Mercadante
Sebastiano
S
Fulfaro
Fabio
F
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000818:Animals; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D010146:Pain / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D005283:Fentanyl