• Dagny Faksvåg Haugen, Marianne Jensen Hjermstad, Neil Hagen, Augusto Caraceni, Stein Kaasa, and European Palliative Care Research Collaborative (EPCRC).
• Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway The Cancer Center, Oslo University Hospital, Ullevål, Oslo, Norway Tom Baker Cancer Centre, Alberta Cancer Board, Division of Palliative Medicine, University of Calgary, Calgary, Alberta, Canada Palliative Care (Pain Therapy, Rehabilitation), Fondazione IRCCS, National Cancer Institute, Milan, Italy Palliative Medicine Unit, Department of Oncology, St Olavs Hospital, Trondheim, Norway.
• Pain. 2010 Jun 1; 149 (3): 476-482.

AbstractTemporal variations in cancer pain intensity are highly prevalent, and are often difficult to manage. However, the phenomenon is not well understood: several definitions and approaches to classification and bedside assessment of cancer breakthrough pain (BTP) have been described. The present study is a systematic review of published literature on cancer BTP to answer the following questions: which terms and definitions have been used; are there validated assessment tools; which domains of BTP do the tools delineate, and which items do they contain; how have assessment tools been applied within clinical studies; and are there validated classification systems for BTP. A systematic search of the peer-reviewed literature was performed using five major databases. Of 375 titles and abstracts initially identified, 51 articles were examined in detail. Analysis of these publications indicates a range of overlapping but distinct definitions have been used to characterize BTP; 42 of the included papers presented one or more ways of classifying BTP; and while 10 tools to assess patients' experience of BTP were identified, only 2 have been partially validated. We conclude that there is no widely accepted definition, classification system or well-validated assessment tool for cancer-related breakthrough pain, but there is strong concurrence on most of its key attributes. With further work in this area, an internationally agreed upon definition and classification system for cancer-related breakthrough pain, and a standard approach on how to measure it, hold the promise to improve patient care and support research in this poor-prognosis cancer pain syndrome.

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