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What is Breakthrough Cancer Pain (BTcP)?

BTcP is a severe transient pain that happen on a chronic background pain already treated with an opioids.

BTcP has a prevalence of up to 95%, (Zeppetella & Ribeiro 2003).
Although patients with all types of cancer and at all disease stages are affected, it is more frequent as the underlying disease progresses, (Foley, 2004).
BTcP is commonly described as a "transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger despite relatively stable and adequately controlled background pain1", (Davies et al., 2009).

A typical BTcP episode (see Figure):

1-    is moderate to severe in pain intensity,
2-    reaches peak intensity in about 3 minutes,
3-    lasts for 30 minutes (range: 1 minute to 2 hours)
(Portenoy et al., 1990)

There are several BTcP episodes per day. Baseline pain treatment management has to be reassessed if more than 4 daily BTcP episodes are reported (Bennett et al., 2005).
The ethiology of BTcP episode is most of the time the same than the persistent background pain, (Bennett et al., 2005a).
Although some patients can identify pain triggers, 78.2% of BTcP episodes are unpredictable in nature, (Portenoy et al., 1999).

Why is it important to treat BTcP?

Breakthrough cancer Pain strikes very quickly and without warning in many cases. Untreated Breakthrough cancer Pain can reduce quality of life for patients with cancer by negatively affecting their mood and their ability to interact with other people, and by limiting daily activities.

Dr. Xavier Amores
CNS/Pain Medical Affairs Director
Cephalon Europe
(08/04/11)

Zeppetella G, Ribeiro MD. Expert Opin Pharmacother. 2003; 4: 493-502.
Foley KM. 2004 In Doyle et al., (Ed) Oxford Textbook of Palliative Medicine (3rd Ed). Oxford University Press.
Portenoy RK, Hagen NA. Pain. 1990; 41: 273-281. Portenoy RK et al., Pain. 1999; 81:129-134.
Bennett D et al., Pharm Therap. 2005; 30: 296-301.