• Sebastiano Mercadante, Alessandro Valle, Giampiero Porzio, Federica Aielli, Claudio Adile, Corrado Ficorella, Maurizio Raineri, Antonino Giarratano, and Alessandra Casuccio.
• Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
• Curr Med Res Opin. 2013 Jun 1;29(6):667-71.

BackgroundThe different operational definitions of breakthrough cancer pain (BTcP) has generated unclear epidemiological data.MethodsA consecutive sample of patients was categorized on the basis of their background pain intensity, background analgesic treatment, and the presence of BTcP.ResultsA total of 265 patients were surveyed; 117 patients had background pain and 91 patients presented peaks of pain intensity distinguishable from background pain. Of 117 patients with background pain, 49 patients were re-assessed after optimization of background analgesia (T1) within a mean of 8.2 days. Pain intensity significantly decreased in comparison with values recorded at admission (p < 0.0005); 75.5% of these patients had BTcP episodes, with a significant decrease in the number BTcP episodes in comparison with T0 (p < 0.0005). The mean BTcP intensity was significantly lower in comparison with T0 (p < 0.0005). Finally, the mean duration of untreated BTcP episodes decreased significantly in comparison with T0 (p = 0.016). After optimization of analgesic therapy, most patients with moderate or severe background pain receiving opioids for moderate pain, patients with moderate or severe pain receiving strong opioids, and patients with moderate or severe pain receiving no opioids moved to the group of patients with mild pain receiving strong opioids. The difference was significant (p = 0.022).ConclusionPatients having good pain control after optimization of the analgesic regimen may have a decrease in number, intensity, and duration of BTcP, although the general prevalence of BTcP remains unchanged.

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