INCREASING EXPERTISE IN PATIENT-CENTRED BREAKTHROUGH CANCER PAIN MANAGEMENT USING RAPID-ONSET OPIOIDS: FOCUS ON SUBLINGUAL FENTANYL CITRATE
Main Article Content
Abstract
Cancer pain represents a very frequent symptom in cancer patients; it is one of the factors which most impacts their quality of life, and clinicians often experience issues regarding its management. This study focuses on Breakthrough cancer pain which is defined as a transient episode of severe pain in a context of adequately controlled background pain. It has a higher prevalence in advanced disease and in palliative care settings; however, it is present throughout all phases of cancer treatment and follow-up. It should not be considered as a single entity, as it is classified as spontaneous, incident volitional or incident non-volitional. To allow a proper diagnosis, clinicians may leverage specific useful tools, such as the Breakthrough Pain Assessment Tool, and patient-reported outcome measures, using a patient-centred care approach. Breakthrough cancer pain treatment requires Rapid-Onset Opioids, namely rapid-active fentanyl formulations having an onset of effect of less than 15 minutes and a short duration of effect. There are different Rapid-Onset Opioids with different routes of administrations which clinicians can choose according to patient characteristics and preferences. For instance, sublingual fentanyl citrate has an innovative formulation which provides a very rapid onset of action, approximately 6 minutes, giving rapid pain relief; intranasal Rapid-Onset Opioids could be preferable in patients with mucositis or with xerostomia. Opioid use in background cancer pain and Breakthrough cancer pain are a cornerstone of treatment.
Perspective: In the treatment of cancer patients, pain management is of paramount importance, given its impact on the quality of life. A correct diagnosis of Breakthrough cancer pain and proper framing of the patient suffering from it allows for the best management of this issue by using Rapid-Onset Opioids.
Keywords:
Breakthrough cancer pain, Rapid-Onset Opioids, Patient-centred care
Article Details
How to Cite
ROMUALDI, Patrizia et al.
INCREASING EXPERTISE IN PATIENT-CENTRED BREAKTHROUGH CANCER PAIN MANAGEMENT USING RAPID-ONSET OPIOIDS: FOCUS ON SUBLINGUAL FENTANYL CITRATE.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6417>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6417.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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5. Deandrea S, Corli O, Consonni D, et al. Prevalence of Breakthrough Cancer Pain: A Systematic Review and a Pooled Analysis of Published Literature. J Pain Symptom Manage. 2014;47(1):57–76.
6. Romualdi, P., Candeletti S. Fentanyl citrate sublingual formulation (Vellofent®) for quick BTcP hindering. Minerva Med. 2016;107(2):114–22.
7. Roberto A, Greco MT, Uggeri S, et al. Living systematic review to assess the analgesic undertreatment in cancer patients. Pain Practice. 2022;22(4):487–96.
8. Fallon M, Giusti R, Aielli F, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines † Clinical Practice Guidelines. ESMO Updated Clinical Practice Guidelines. 2018; 29(July):iv166–91.
9. Zucco F, Bonezzi C, Fornasari D. Breakthrough Cancer Pain (BTcP): a Synthesis of Taxonomy, Pathogenesis, Therapy, and Good Clinical Practice in Adult Patients in Italy. Adv Ther. 2014;31:657–82.
10. Portenoy RK HNA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41(3):273–81.
11. Mercadante S, Radbruch L, Caraceni A, et al. Episodic ( Breakthrough ) Pain Consensus Conference of an Expert Working Group of the European Association for Palliative Care. Cancer. 2002;94(3):832–9.
12. Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G. The management of cancer-related breakthrough pain : Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. European Journal of Pain. 2009;13(4): 331–8.
13. Wordliczek J, Zajaczkowska R. Mechanisms in Cancer Pain. In: Cancer Pain. 2013. p. 47–70.
14. Caraceni A, Bertetto O, Labianca R, et al. Episodic (breakthrough) pain prevalence in a population of cancer pain patients. comparison of clinical diagnoses with the QUDEI-Italian questionnaire for intense episodic pain. J Pain Symptom Manage. 2012;43(5):833–41.
15. Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and Molecular Mechanisms of Pain. Cell. 2009;139(2):267–84.
16. Meacham K, Shepherd A, Haroutounian S. Neuropathic Pain : Central vs. Peripheral Mechanisms. Curr Pain Headache Rep. 2017;21(28).
17. Kuner R. Central mechanisms of pathological pain. Nat Med. 2010;16(11):1258–66.
18. Bak MS, Park H, Kim SK. Neural Plasticity in the Brain during Neuropathic Pain. Biomedicines. 2021;9(624):1–17.
19. Raja S, Carr D, Cohen M, et al. The Revised IASP definition of pain: concepts, challenges, and compromises. Pain [revista en Internet] 2021 [acceso 4 de marzo de 2022]; 161(9): 1-16. Pain. 2021;161 (9):1976–82.
20. Cohen SP, Vase L, Hooten WM. Chronic pain : an update on burden , best practices , and new advances. The Lancet. 2021;397:2082–97.
21. Yang H, Hurwitz EL, Li J, et al. Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults. Int J Environ Res Public Health. 2023 Mar 1;20(5).
22. Bäckryd E, Alföldi P. Chronic pain and its relationship with anxiety and depression. 2023.
23. Torta RGV, Munari J. Symptom cluster: Depression and pain. Vol. 19, Surgical Oncology. 2010. p. 155–9.
24. Portenoy RK, Payne D JP. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81(1–2):129–34.
25. Husic S, Imamovic S, Matic S, Sukalo A. Characteristics and Treatment of Breakthrought Pain ( BTcP ) in Palliative Care. Med Arch. 2017; 71(4):246–50.
26. Camps Herrero C, Reina Zoilo JJ, Monge Martín D, et al. Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP). Clinical and Translational Oncology. 2019;21(3):380–90.
27. Kwon JH. Overcoming barriers in cancer pain management. Journal of Clinical Oncology. 2014;32(16):1727–33.
28. Carulla Torrent J, Jara Sánchez C, Sanz Ortiz J, et al. Oncologists’ perceptions of cancer pain management in Spain: The real and the ideal. European Journal of Pain. 2007;11(3):352–9.
29. Breivik H, Cherny N, Collett B, et al. Cancer-related pain: A pan-European survey of prevalence, treatment, and patient attitudes. Annals of Oncology. 2009;20(8):1420–33.
30. Margarit C, Juliá J, López R, et al. Breakthrough cancer pain - Still a challenge. J Pain Res. 2012;5:559–66.
31. Liossi C, Green K, Schoth DE, et al. A Systematic Review of Measures of Breakthrough Pain and Their Psychometric Properties. J Pain Symptom Manage. 2021;62(5):1041–64.
32. Webber K, Davies AN, Zeppetella G, Cowie MR. Development and Validation of the Breakthrough Pain Assessment Tool ( BAT ) in Cancer Patients. J Pain Symptom Manage. 2014;48(4):619–31.
33. Hagen NA, Stiles C, Nekolaichuk C, et al. The Alberta Breakthrough Pain Assessment Tool for Cancer Patients : A Validation Study Using a Delphi Process and Patient Think-Aloud Interviews. Journal of Pain and Symptom Management Pain and Symptom Management. 2008;35(2):136–52.
34. Gedaliahu B, Dekel S, Gori A, et al. The Italian Questionnaire for Cancer Breakthrough Pain Diagnosis, a Multicenter Validation Study. Pain Ther. 2021;10(2):1171–88.
35. Boceta J, Samper D, de la Torre A, Sánchez-de la Rosa R GG. Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain. JMIR Cancer. 2019;5(1):e10187.
36. Yang J, Weng LZ, Chen ZK et al. Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019;7(5):e12542.
37. Fix GM, Vandeusen C, Edd L, et al. Patient- centred care is a way of doing things : How healthcare employees conceptualize patient- centred care. Health Expectations. 2018;21(1):300–7.
38. Pain T, Girgis A, Hoffman A, et al. Patient-¬ reported outcome measures (PROMs) to guide clinical care: recommendations and challenges. Med J Aust. 2022;17(2016):9–11.
39. Velikova G, Booth L, Smith AB et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol. 2004;22:714–24.
40. Abahussin AA, West RM, Wong DC, Ziegler LE. PROMs for Pain in Adult Cancer Patients : A Systematic Review of Measurement Properties. Pain Practice. 2019;19(1):93–117.
41. Davies A, Buchanan A, Zeppetella G, et al. Breakthrough Cancer Pain : An Observational Study of 1000 European Oncology Patients. J Pain Symptom Manage. 2013;46(5):619–28.
42. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain : evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13:58–68.
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