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.