Management of breakthrough pain in cancer patients

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Background. Breakthrough pain reflects a transitory exacerbation of pain that breaks through chronic pain (background, or persistent, or basal pain) which is controlled by around-the-clock medication (opioids). Materials and method. We assessed 107 patients treated with strong opioids (oxycodone) for baseline pain. Thirty-three patients needed the second opioid for breakthrough pain. We evaluated the pain intensity in patients who presented breakthrough pain, before and after the initiation of the treatment. Results. The patients’ distribution according to the dose of strong opioids with immediate release, per day, for breakthrough pain, was the following: morphine 20 mg – 2 patients, 40 mg – 3 patients; morphine sulphate tablets immediate release 20 mg – 3 patients, 30 mg – 1 patient, 40 mg – 21 patients, 60 mg – 1 patient, 80 mg – 1 patient; fentanyl tablets with immediate release – 1 patient. Discussion and conclusions. Basal pain lasts more than 12 hours per day and is controlled by the around-the-clock medication (opioids). The assessment of breakthrough pain is very important (physical examination, evaluation of the extent of the disease, pain history, pain intensity, temporal features, and interference with activity). Breakthrough pain has an important prevalence and a negative impact on the quality of life of cancer patients. Managing breakthrough pain leads to an improved quality of life, which has positive outcomes for patients. These outcomes will be reflected in their physical and psychological symptoms, and also in their social life.