Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group

Abstract

Controversies exist about the definition and epidemiology of breakthrough cancer pain (BTcP), the pharmacological treatment options, drug dosing, and how to select the medications for BTcP among the new fentanyl products. Existing data were critically evaluated to provide recommendations by an expert group. An algorithm to diagnose BTcP should be used followed by a careful assessment. Fentanyl products provide efficacy and rapidity of action to counteract the temporal pattern of BTcP. The doses of opioids used for background pain should guide the choice of the doses of fentanyl products. The choice of fentanyl products should be based on individual clinical conditions.

Appendix

The IOPS MS Study Group

Mediati Rocco Domenico⁶, Caruselli Amanda¹,Costanzi Andrea², Russo Gennaro³, Bracchi Paola⁴, Dodaro Lucia⁵, Contu Viviana⁸, Fora Gianluca⁸, Veronese Barbara¹⁰, Alu Massimiliano¹¹, Chiurazzi Bruno¹², Sgarlata Massimiliano¹³, Kasa Alma¹⁴, Donelli Emanuela¹⁵, Silvestro Stefania¹⁵, Romano Carmela¹⁷, Ghidoni Silvia¹⁸, Palermo Loredana¹⁹, Pisanu Giovanni Maria ²⁰, Imperatori Luca²¹, Diacciati Sara²², Samolsky Dekel Boaz²³, Bruno Emanuela²⁴, Saulle Serena²⁵, Bonotto Marta²⁶, De santis Stefano²⁷, Tammaro Dario²⁸, Ginocchi Laura²⁹, Zampieri Mari³¹, Fioroni Iacopo³², Gallo Gloria³³, Saber Benhaz³³.

Dauri Mario⁷, Airoldi Mario⁸, Azzarello Giuseppe⁹, Bandera Mauro¹⁰, Blasi Livio¹¹, Carteni Giacomo¹², Costanzo Veruska¹³, Degiovanni Daniela¹⁴, Fusco Flavio¹⁵, Guardamagna Vittorio¹⁶, Iaffaioli Vincenzo¹⁷, Lazzari Marzia⁷, Liguori Simeone¹⁸, Lorusso Vito¹⁹, Mameli Sergio ²⁰, Mattioli Rodolfo²¹, Mazzei Teresita²², Melotti Rita Maria²³, Menardo Valentino²⁴, Miotti Danilo²⁵, Moroso Stefano²⁶, Natoli Silvia⁷, Orsetti Remo²⁷, Papa Alfonso²⁸, Ricci Sergio²⁹, Sabato Alessandro Fabrizio⁷, Scelzi Elvira³⁰, Sofia Michele³¹, Tonini Giuseppe³², Valle Alessandro³³

^{6 Pain Relief, Palliative Care, Oncology Department, Careggi Hospital, Florence Primary Care Unit, ASL RME, Rome,}

^{7 Emergency care, Critical care Medicine, pain Medicine and Anesthesiologydepartement, Tor Vergata University of Rome}

^{8 2nd Medical Oncology Division, Cittàdella Salute e dellaScienza Hospital of Turin, Turin}

^{9 Dip SpecialitàMediche, UOCOncologiaedEmatologiaOncologica; ASL 13 Mirano, Venezia, Italia}

^{10 Ospedaliera Papa Giovanni XXIII - Unit of Paliative Care and Pain Therapy, Bergamo, Italy}

^{11 Medical Oncology Unit, ARNAS Civico, Palermo}

^{12 Medical Oncology, A.O.R.N A. Cardarelli, Naples}

^{13 Palliative Care Unit, SAMO ONLUS, Catania}

^{14 Palliative Care Unit, Ospedale S. Spirito, CasaleMonferrato, Italy}

^{15 SSD Cure Palliative Dipartimento Cure PrimarieedAttivitàDistrettuali ASL3 Genovese}

^{16 UnitàOperativa di Cire Palliative e Terapia del dolore - IRCCS IstitutoEuropeo di Oncologia (IEO) - Milano, Italia}

^{17 Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples}

^{18 Ospedaliera Papa Giovanni XXIII - Unit of Palliative Care and Pain Therapy, Bergamo, Italy}

^{19 Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari}

^{20 Pain Therapy Unit, “A. Businco” Hospital, ASL 8, Cagliari, Italy}

^{21 S. Croce Hospital, Medical Oncology Unit, Fano - Pesaro, Italy}

^{22 Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence}

^{23 Department of Medicine and Surgery Sciences, University of Bologna, Bologna}

^{24 StrutturaSempliceAlgologia, A.O. S. Croce e Carle, Cuneo, Italy}

^{25 Salvatore Maugeri, Foundation IRCCS, Pavia, Italy}

^{26 Medical Oncology, University Hospital S. Maria dellaMisericordia, Udine, Italy}

^{27 Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome}

^{28 Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples}

^{29 Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa}

^{30 U.O OncologiaMedica, P.O. Castelfranco Veneto- Treviso, Italy}

^{31 U.O.C. Cure Palliative, Hospice e Medicina del Dolore. P.O di GarbagnateM.se, Milano}

^{32 Department of Medical Oncology, Campus Bio-Medico University of Rome}

^{33 Cure Palliative, Fondazione FARO, Torino}