title: What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion.
abstract: Clinical management of breakthrough cancer pain (BTcP) is still not satisfactory despite the availability of effective pharmacological agents. This is in part linked to the lack of clarity regarding certain essential aspects of BTcP, including terminology, definition, epidemiology and assessment. Other barriers to effective management include a widespread prejudice among doctors and patients concerning the use of opioids, and inadequate assessment of pain severity, resulting in the prescription of ineffective drugs or doses. This review presents an overview of the appropriate and inappropriate actions to take in the diagnosis and treatment of BTcP, as determined by a panel of experts in the field. The ultimate aim is to provide a practical contribution to the unresolved issues in the management of BTcP. Five 'things to do' and five 'things not to do' in the diagnosis and treatment of BTcP are proposed, and evidence supporting said recommendations are described. It is the duty of all healthcare workers involved in managing cancer patients to be mindful of the possibility of BTcP occurrence and not to underestimate its severity. It is vital that all the necessary steps are carried out to establish an accurate and timely diagnosis, principally by establishing effective communication with the patient, the main information source. It is crucial that BTcP is treated with an effective pharmacological regimen and drug(s), dose and administration route prescribed are designed to suit the particular type of pain and importantly the individual needs of the patient.
authors.affiliation: SOD Cure Palliative e Terapia del Dolore, Ospedale Universitario Careggi, Florence, Italy. renato.vellucci@gmail.com.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-5462-7920
authors.initials: R
authors.lastname: Vellucci
authors.affiliation: SC Anestesia, Rianimazione e Terapia Antalgica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fanelli
authors.affiliation: Fondazione ANT Italia Onlus, Andria, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pannuti
authors.affiliation: SC Cure Palliative, Ospedale di Biella, Ponderano, BI, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Peruselli
authors.affiliation: UO Terapia del Dolore, ARNAS Civico di Palermo, Palermo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Adamo
authors.affiliation: Hospice e Cure Palliative, ASP 1di Agrigento, Agrigento, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Alongi
authors.affiliation: UOC Terapia del Dolore e Cure Palliative, Azienda ospedaliera di Cosenza, Cosenza, Italy.|Past President Feder Dolore-SICD, Cosenza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Amato
authors.affiliation: Struttura di Medicina del Dolore, Ospedale Universitario "Ospedali Riuniti", Foggia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Consoletti
authors.affiliation: UOS Cure Palliative e Terapia Antalgica, Azienda ULSS N. 10 "Veneto Orientale", San Donà di Piave, VE, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lamarca
authors.affiliation: USC Cure Palliative Terapia del Dolore, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Liguori
authors.affiliation: UOD Terapia del Dolore e Cure Palliative, ACO San Filippo Neri, ASLRME, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Lo Presti
authors.affiliation: Terapia antalgica e Cure Palliative, Presidio Ospedaliero "S. Maria della Pietà", Nola, NA, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Maione
authors.affiliation: SC Terapia del Dolore, Presidio Ospedaliero "A. Businco", Cagliari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Mameli
authors.affiliation: Scuola di Specializzazione di Anestesia, Rianimazione e Terapia Intensiva, Università dell'Aquila, L'Aquila, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marinangeli
authors.affiliation: OC Anestesia, Rianimazione e Terapia Iperbarica, UOS-I Gruppo Operatorio, Ospedale "Vito Fazzi", Lecce, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Marulli
authors.affiliation: SC Oncologia Medica, Azienda Ospedaliera "S.M. della Misericordia", Perugia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Minotti
authors.affiliation: UO Cure Palliative e Terapia del Dolore, Fondazione Salvatore Maugeri-IRCCS, Pavia, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Miotti
authors.affiliation: UO Semplice Cure Palliative, Ravenna, Italy.|Dipartimento Onco-ematologico, AUSL della Romagna c/o Presidio Ospedaliero Umberto I, Lugo di Ravenna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Montanari
authors.affiliation: UOS Hospice, Azienda Sanitaria Provinciale di Siracusa, Siracuse, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Moruzzi
authors.affiliation: UOC Terapia Antalgica, IRCCS San Martino-IST, Genoa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Palermo
authors.affiliation: UOC Anestesia e Rianimazione B, Azienda Universitaria integrata di Verona, Verona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Parolini
authors.affiliation: UO Terapia del Dolore, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Poli
authors.affiliation: Centro di Terapia del Dolore, Hospice "Fondazione Roma Sanità", Rome, Italy.|Centro di Rianimazione e Terapia del Dolore e Cure Palliative, Istituto Nazionale Tumori "Regina Elena", Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Tirelli
authors.affiliation: Fondazione FARO, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Valle
authors.affiliation: Dipartimento di Farmacia e Biotecnologie, Alma mater studiorum, Università di Bologna, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Romualdi
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D055118:Medication Adherence; D009369:Neoplasms / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid