• Erik Torbjørn Løhre, Pål Klepstad, Michael I Bennett, Cinzia Brunelli, Augusto Caraceni, Robin L Fainsinger, Anne Kari Knudsen, Sebastiano Mercadante, Per Sjøgren, Stein Kaasa, and European Association for Palliative Care Research Network.
• European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Electronic address: erik.t.lohre@ntnu.no.
• J Pain Symptom Manage. 2016 Jun 1; 51 (6): 1013-9.

ContextCancer pain can appear with spikes of higher intensity. Breakthrough cancer pain (BTCP) is the most common term for the transient exacerbations of pain, but the ability of the nomenclature to capture relevant pain variations and give treatment guidance is questionable.ObjectivesTo reach consensus on definitions, terminology, and subclassification of transient cancer pain exacerbations.MethodsThe most frequent authors on BTCP literature were identified using the same search strategy as in a systematic review and invited to participate in a two-round Delphi survey. Topics with a low degree of consensus on BTCP classification were refined into 20 statements. The participants rated their degree of agreement with the statements on a numeric rating scale (0-10). Consensus was defined as a median numeric rating scale score of ≥7 and an interquartile range of ≤3.ResultsFifty-two authors had published three or more articles on BTCP over the past 10 years. Twenty-seven responded in the first round and 24 in the second round. Consensus was reached for 13 of 20 statements. Transient cancer pain exacerbations can occur without background pain, when background pain is uncontrolled, and regardless of opioid treatment. There exist cancer pain exacerbations other than BTCP, and the phenomenon could be named "episodic pain." Patient-reported treatment satisfaction is important with respect to assessment. Subclassification according to pain pathophysiology can provide treatment guidance.ConclusionSignificant transient cancer pain exacerbations include more than just BTCP. Patient input and pain classification are important factors for tailoring treatment.Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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