DOI: https://doi.org/10.14710/jai.v0i0.44701

Breakthrough Cancer Pain: The Current Pharmacological Management

1Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia

2Universitäts-Klinikum Bonn und Medizinische Fakultät, Bonn, Indonesia

Received: 11 Feb 2022; Revised: 28 Mar 2022; Accepted: 29 Mar 2022; Available online: 15 Sep 2022; Published: 31 Mar 2022.
Open Access Copyright 2022 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Background: Breakthrough pain (BTP) is a transient increase in pain that occurs on a background of stable pain. It contributes substantially to the suffering experienced by most cancer patients. The pharmacologic options for management of BTP have been expanded considerably in the past decade. Opioids remain the most effective pharmaceuticals used for the BTP case. In this systematic review we attempted to provide the currently available clinical data about pharmacological treatment for breakthrough cancer pain.

Objective: To evaluate the efficacy of pharmacological treatments for Breakthrough pain

Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed for the last ten years (from September 2010 to September 2020. Further potentially relevant studies were identified from reference lists of studies marked for inclusion and relevant reviews. Two review authors independently assessed trial quality and extracted data. We screened the search results and included studies if they met the selection criteria.

Result: We screened 205 publications of which 14 met the inclusion criteria. In total, we analysed data from 2129 participants. Overall, participant with BTP were treated with short acting opioid. Literature searching did not find any published evidence of non opioid drug to treat the BTP. Most adverse effects of the investigated drugs seemed to be moderate.

Conclusion: The findings of this review suggest that rapid onset opioids play significant role for BTP. Future studies may be conducted to explore the efficacy and safety profiles each regimen for patients with certain categories of cancer.

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Keywords: breakthrough pain; episodic pain; cancer pain; chronic pain; pharmacological treatment

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Section: Original Articles
Language : EN
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  1. Van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007 Sep 1;18(9):1437–49
  2. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990 Jun;41(3):273–81
  3. Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, et al. Breakthrough Cancer Pain: An Observational Study of 1000 European Oncology Patients. J Pain Symptom Manage. 2013 Nov;46(5):619–28
  4. Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, et al. Episodic (breakthrough) pain. Cancer. 2002 Feb 1;94(3):832–9
  5. Hwang SS, Chang VT, Kasimis B. Cancer breakthrough pain characteristics and responses to treatment at a VA medical center. Pain. 2003 Jan;101(1–2):55–64
  6. Taylor D. What is Cancer Breakthrough Pain? In: Managing Cancer Breakthrough Pain [Internet]. Tarporley: Springer Healthcare Ltd.; 2013 [cited 2018 Dec 4]. p. 13–27. Available from: http://link.springer.com/10.1007/978-1-908517-83-8_2
  7. Mishra S, Bhatnagar S, Chaudhary P, Rana SPS. Breakthrough Cancer Pain: Review of Prevalence, Characteristics and Management. Indian J Palliat Care. 2009;15(1):14–8
  8. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999 May 1;81(1–2):129–34
  9. Bedard G, Hawley P, Zhang L, Slaven M, Gagnon P, Bisland S, et al. A survey of Canadian cancer patients’ perspectives on the characteristics and treatment of breakthrough pain. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2013 Sep;21(9):2557–63
  10. Simmonds MA. Management of breakthrough pain due to cancer. Oncol Williston Park N. 1999 Aug;13(8):1103–8; discussion 1110, 1113–4
  11. Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain Off J Am Pain Soc. 2002 Feb;3(1):38–44
  12. Caraceni A, Davies A, Poulain P, Cortés-Funes H, Panchal SJ, Fanelli G. Guidelines for the management of breakthrough pain in patients with cancer. J Natl Compr Canc Netw. 2013;11(suppl 1):S–29
  13. American Pain Foundation null. Breakthrough cancer pain: mending the break in the continuum of care. J Pain Palliat Care Pharmacother. 2011;25(3):252–64
  14. González-Escalada JR, Camba A, Casas A, Gascón P, Herruzo I, Núñez-Olarte JM, et al. Código de buena práctica para el control del dolor oncológico. Rev Soc Esp Dolor. 2011 Apr;18(2):98–117
  15. Chiu SE. Breakthrough Pain: Assessment and Management in Clinical Practice. 2012 [cited 2017 Mar 3]; Available from: https://research.wsulibs.wsu.edu:8443/xmlui/handle/2376/3676
  16. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012 Feb;13(2):e58–68
  17. Mercadante S. Pharmacotherapy for Breakthrough Cancer Pain. Drugs. 2012 Jan 1;72(2):181–90
  18. Bennett D, Burton AW, Fishman S, Fortner B. PART 2 MANAGEMENT. Pharm Ther. 2005;30(6):354–361
  19. Zeppetella G. Breakthrough pain should be distinguished from background pain [Internet]. Guidelines in Practice. [cited 2018 Oct 17]. Available from: https://www.guidelinesinpractice.co.uk/pain/breakthrough-pain-should-be-distinguished-from-background-pain/306787.article
  20. Jenkins Abi. How to manage breakthrough pain. Pharm J [Internet]. 2009 [cited 2018 Oct 17]; Available from: https://www.pharmaceutical-journal.com/careers-and-jobs/careers-and-jobs/career-feature/how-to-manage-breakthrough-pain/10377845.article
  21. Mercadante S, Adile C, Cuomo A, Aielli F, Cortegiani A, Casuccio A, et al. Fentanyl Buccal Tablet vs. Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Randomized, Crossover, Comparison Study. J Pain Symptom Manage. 2015 Nov;50(5):579–86
  22. Mercadante S, Aielli F, Adile C, Costanzi A, Casuccio A. Fentanyl Pectin Nasal Spray Versus Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Comparative Study. J Pain Symptom Manage. 2016 Jul 1;52(1):27–34
  23. Ashburn MA, Slevin KA, Messina J, Xie F. The Efficacy and Safety of Fentanyl Buccal Tablet Compared with Immediate-Release Oxycodone for the Management of Breakthrough Pain in Opioid-Tolerant Patients with Chronic Pain: Anesth Analg. 2011 Mar;112(3):693–702
  24. Doulton B. Pharmacologic management of adult breakthrough cancer pain. Can Fam Physician. 2014 Dec;60(12):1111–4
  25. Davies A, Kleeberg UR, Jarosz J, Mercadante S, Poulain P, O’Brien T, et al. Improved patient functioning after treatment of breakthrough cancer pain: an open-label study of fentanyl buccal tablet in patients with cancer pain. Support Care Cancer. 2015 Jul;23(7):2135–43
  26. Kleeberg UR, Davies A, Jarosz J, Mercadante S, Poulain P, O’Brien T, et al. Pan-European, open-label dose titration study of fentanyl buccal tablet in patients with breakthrough cancer pain. Eur J Pain. 2015 Apr 1;19(4):528–37
  27. Kosugi T, Hamada S, Takigawa C, Shinozaki K, Kunikane H, Goto F, et al. A Randomized, Double-Blind, Placebo-Controlled Study of Fentanyl Buccal Tablets for Breakthrough Pain: Efficacy and Safety in Japanese Cancer Patients. J Pain Symptom Manage. 2014 Jun 1;47(6):990–1000
  28. Takigawa C, Goto F, Tanda S, Shima Y, Yomiya K, Matoba M, et al. Breakthrough pain management using fentanyl buccal tablet (FBT) in combination with around-the-clock (ATC) opioids based on the efficacy and safety of FBT, and its relationship with ATC opioids: results from an open-label, multi-center study in Japanese cancer patients with detailed evaluation. Jpn J Clin Oncol. 2015 Jan;45(1):67–74
  29. Davies A, Sitte T, Elsner F, Reale C, Espinosa J, Brooks D, et al. Consistency of Efficacy, Patient Acceptability, and Nasal Tolerability of Fentanyl Pectin Nasal Spray Compared with Immediate-Release Morphine Sulfate in Breakthrough Cancer Pain. J Pain Symptom Manage. 2011 Feb 1;41(2):358–66
  30. Fallon M, Reale C, Davies A, Lux AE, Kumar K, Stachowiak A, et al. Efficacy and Safety of Fentanyl Pectin Nasal Spray Compared with Immediate-Release Morphine Sulfate Tablets in the Treatment of Breakthrough Cancer Pain: A Multicenter, Randomized, Controlled, Double-Blind, Double-Dummy Multiple-Crossover Study. J Support Oncol. 2011 Nov;9(6):224–31
  31. Mercadante S, Radbruch L, Davies A, Poulain P, Sitte T, Perkins P, et al. A comparison of intranasal fentanyl spray with oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: an open-label, randomised, crossover trial. Curr Med Res Opin. 2009 Nov;25(11):2805–15
  32. Kongsgaard UE, Eeg M, Greisen H. The use of Instanyl® in the treatment of breakthrough pain in cancer patients: a 3-month observational, prospective, cohort study. Support Care Cancer. 2014;22(6):1655–62
  33. Velázquez Rivera I, Muñoz Garrido JC, García Velasco P, España Ximénez de Enciso I, Velázquez Clavarana L. Efficacy of Sublingual Fentanyl vs. Oral Morphine for Cancer-Related Breakthrough Pain. Adv Ther. 2014 Jan;31(1):107–17
  34. Rauck R, North J, Gever LN, Tagarro I, Finn AL. Fentanyl buccal soluble film (FBSF) for breakthrough pain in patients with cancer: a randomized, double-blind, placebo-controlled study. Ann Oncol. 2010 Jun;21(6):1308–14
  35. Portenoy RK, Burton AW, Gabrail N, Taylor D. A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain: Pain. 2010 Dec;151(3):617–24

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