Factors influencing the clinical presentation of breakthrough pain in cancer patients

S. Mercadante, P. Marchetti, A. Cuomo, A. Caraceni, R.D. Mediati, R. Vellucci, M. Mammucari, S. Natoli, M. Lazzari, M. Dauri, C. Adile, M. Airoldi, G. Azzarello, M. Bandera, L. Blasi, G. Cartenì, B. Chiurazzi, B.V.P. Costanzo, D. Degiovanni, F. FuscoV. Guardamagna, V. Iaffaioli, S. Liguori, L. Palermo, S. Mameli, F. Masedu, R. Mattioli, T. Mazzei, R.M. Melotti, V. Menardo, D. Miotti, S. Moroso, G. Pascoletti, S. De Santis, R. Orsetti, A. Papa, S. Ricci, E. Scelzi, M. Sofia, G. Tonini, A. Valle, F. Aielli, IOPS-MS Study Group

Research output: Contribution to journalArticlepeer-review


Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Original languageEnglish
Issue number6
Publication statusPublished - 2018


  • Breakthrough pain
  • Cancer
  • Palliative care
  • Supportive care
  • analgesic agent
  • antiinflammatory agent
  • buprenorphine
  • codeine
  • fentanyl
  • hydromorphone
  • methadone
  • morphine
  • naloxone plus oxycodone
  • opiate
  • oxycodone
  • paracetamol
  • tapentadol
  • tramadol
  • adult
  • aged
  • analgesia
  • Article
  • breakthrough pain
  • cancer diagnosis
  • cancer patient
  • clinical feature
  • confusion
  • constipation
  • daily life activity
  • female
  • head and neck cancer
  • headache
  • human
  • Karnofsky Performance Status
  • major clinical study
  • male
  • metastasis
  • multicenter study
  • nausea
  • neuropathic pain
  • pain intensity
  • unspecified side effect
  • vomiting


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