Cancer Breakthrough Pain: Clinical Assessment and Management

Breakthrough pain (BTP) has been defined as a transient exacerbation of pain that occurs to patients with otherwise stable baseline persistent pain. It is one of the most prevalent and formidable symptoms cancer patients have to face which can be classified into 4 types: predictable incident pain, unpredictable incident pain, idiopathic pain, and end-of-dose pain. Because of the characteristics of BTP, its management should be based on a consistent definition and thorough assessment including the determination of intensity, quality, duration, and other factors related to current treatment and so on. Medical treatment aims at reducing the frequency and intensity of BTP. Medication effectiveness should be sufficient for patients’ daily living activities, and devoid of side effects, dependence or drug–drug interactions. BTP should be clearly distinguished from chronic pain. Clinicians should be capable of using assessment tools for further identification and individual management. It is worth probing into these issues further in Taiwan from the aspects of different races, cancer types, and disease stages to evaluate the quality of patients’ pain control during and after cancer therapy and to develop appropriate local management and guidelines.