Breakthrough cancer pain: An observational study of 1000 european oncology patients

Andrew Davies, Alison Buchanan, Giovambattista Zeppetella, Josep Porta-Sales, Rudolf Likar, Wolfgang Weismayr, Ondrej Slama, Tarja Korhonen, Marilene Filbet, Philippe Poulain, Kyriaki Mystakidou, Alexandros Ardavanis, Tony O'Brien, Pauline Wilkinson, Augusto Caraceni, Furio Zucco, Wouter Zuurmond, Steen Andersen, Anette Damkier, Tove VejlgaardFriedemann Nauck, Lukas Radbruch, Karl Fredrik Sjolund, Mariann Stenberg

Research output: Contribution to journalArticle


Context: Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients. Objectives: The aim of this study was to characterize breakthrough pain in a diverse population of cancer patients. Methods: The study involved 1000 cancer patients from 13 European countries. Patients were screened for breakthrough pain using a recommended diagnostic algorithm and then questioned about the characteristics and management of their pain. Results: Of the 1000 patients, 44% reported incident pain, 41.5% spontaneous pain, and 14.5% a combination. The median number of episodes was three a day. The median time to peak intensity was 10 minutes, with the median for patients with incident pain being five minutes (P <0.001). The median duration of untreated episodes was 60 minutes, with the median for patients with incident pain being 45 minutes (P = 0.001). Eight hundred six patients stated that pain stopped them doing something, 66 that it sometimes stopped them doing something, and only 107 that it did not interfere with their activities. Patients with incident pain reported more interference with walking ability and normal work, whereas patients with spontaneous pain reported more interference with mood and sleep. As well, 65.5% of patients could identify an intervention that improved their pain (29.5%, pharmacological; 23%, nonpharmacological; 12%, combination). Regarding medications, 980 patients were receiving an opioid to treat their pain, although only 191 patients were receiving a transmucosal fentanyl product licensed for the treatment of breakthrough pain. Conclusion: Breakthrough cancer pain is an extremely heterogeneous condition.

Original languageEnglish
Pages (from-to)619-628
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number5
Publication statusPublished - Nov 2013


  • breakthrough pain
  • cancer
  • Pain
  • palliative care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Nursing(all)

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    Davies, A., Buchanan, A., Zeppetella, G., Porta-Sales, J., Likar, R., Weismayr, W., Slama, O., Korhonen, T., Filbet, M., Poulain, P., Mystakidou, K., Ardavanis, A., O'Brien, T., Wilkinson, P., Caraceni, A., Zucco, F., Zuurmond, W., Andersen, S., Damkier, A., ... Stenberg, M. (2013). Breakthrough cancer pain: An observational study of 1000 european oncology patients. Journal of Pain and Symptom Management, 46(5), 619-628.