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Different definitions of breakthrough pain (BTP) influence the observed BTP prevalence. This study examined BTP prevalence variability due to use of different cutoffs for controlled background pain, different assessment periods for background pain, and difference between worst and average pain intensity (PI).
Cancer patients from the EPCRC-CSA study who reported flare-ups of pain past 24 h were potential BTP cases. BTP prevalence was calculated for different cutoffs for background PI on numeric rating scales (NRS 0–10) for the past week, past 48 and past 24 h period. Furthermore, BTP cases were categorized based on the difference between maximum and average PI past 24 h (range, 0 to > 2 points, NRS 0–10).
Of 696 respondents, 302 patients (43.4%) reported pain flares the past 24 h. The BTP prevalence when using a defined background PI ≤ 4 for the past week was 19.8%. This number varied for different defined cutoffs for background PI. Actual background PI and BTP prevalence also varied between the assessment periods “past week”, “past 48 h”, and “past 24 h” (PI 4.0, 3.6, and 3.4; BTP prevalence 19.8, 22.7, and 24.9% for background PI ≤ 4). For patients with background PI ≤ 4 past week, 105 had a difference between maximum and average PI ≥ one point and 48 had a difference > two points.
The reported BTP prevalence is dependent on the cutoff for background PI in the BTP definition, population background PI during the assessment period, and defined cutoff for the difference between worst and average PI.
NTNU, Norwegian University of Science and Technology.
Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manag. 2014;47(1):57–76. CrossRef
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. Eur J Pain. 2009;13(4):331–8. CrossRef
Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Mammucari M, et al. Breakthrough cancer pain: preliminary data of the Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS). Adv Ther. 2017;34(1):120–35. CrossRef
Mercadante S, Lazzari M, Reale C, Cuomo A, Fusco F, Marchetti P, et al. Italian Oncological Pain Survey (IOPS): a multicentre Italian study of breakthrough pain performed in different settings. Clin J Pain. 2015;31(3):214–21. CrossRef
Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41(3):273–81. CrossRef
Mercadante S, Portenoy RK. Breakthrough cancer pain: twenty-five years of study. Pain. 2016;157(12):2657–63. CrossRef
Caraceni A, Bertetto O, Labianca R, Maltoni M, Mercadante S, Varrassi G, 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 Manag. 2012;43(5):833–41. CrossRef
Gatti A, Gentili M, Baciarello M, Lazzari M, Marzi R, Palombo E, et al. Breakthrough pain in patients with controlled or uncontrolled basal pain: an observational study. Pain Res Manag J Can Pain Soc journal de la societe canadienne pour le traitement de la douleur. 2014;19(6):e168–71.
Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81(1–2):129–34. CrossRef
Davies A, Buchanan A, Zeppetella G, Porta-Sales J, Likar R, Weismayr W, et al. Breakthrough cancer pain: an observational study of 1000 European oncology patients. J Pain Symptom Manag. 2013;46(5):619–28. CrossRef
Shi Q, Wang XS, Mendoza TR, Pandya KJ, Cleeland CS. Assessing persistent cancer pain: a comparison of current pain ratings and pain recalled from the past week. J Pain Symptom Manag. 2009;37(2):168–74. CrossRef
Jensen MP, Wang W, Potts SL, Gould EM. Reliability and validity of individual and composite recall pain measures in patients with cancer. Pain Med. 2012;13(10):1284–91. CrossRef
Shi Q, Trask PC, Wang XS, Mendoza TR, Apraku WA, Malekifar M, et al. Does recall period have an effect on cancer patients’ ratings of the severity of multiple symptoms? J Pain Symptom Manag. 2010;40(2):191–9. CrossRef
Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL. Defining the clinically important difference in pain outcome measures. Pain. 2000;88(3):287–94. CrossRef
Farrar JT, Polomano RC, Berlin JA, Strom BL. A comparison of change in the 0–10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity. Anesthesiology. 2010;112(6):1464–72. CrossRef
Mercadante S, Adile C, Torta R, Varetto A, Fulfaro F, Giarratano A, et al. Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients. Curr Med Res Opin. 2013;29(1):93–7. CrossRef
Oldenmenger WH, de Raaf PJ, de Klerk C, van der Rijt CC. Cut points on 0–10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review. J Pain Symptom Manag. 2013;45(6):1083–93. CrossRef
Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe—grading pain severity by its interference with function. Pain. 1995;61(2):277–84. CrossRef
Hui D, Shamieh O, Paiva CE, Perez-Cruz PE, Kwon JH, Muckaden MA, et al. Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: a prospective, multicenter study. Cancer. 2015;121(17):3027–35. CrossRef
Lohre ET, Klepstad P, Bennett MI, Brunelli C, Caraceni A, Fainsinger RL, et al. From “breakthrough” to “episodic” cancer pain? A European Association for palliative care research network expert Delphi survey toward a common terminology and classification of transient cancer pain exacerbations. J Pain Symptom Manag. 2016;51(6):1013–9. CrossRef
Mercadante S, Marchetti P, Cuomo A, Mammucari M, Caraceni A, IOPS MS Study Group. Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group. Support Care Cancer. 2016;24(2):961–8. CrossRef
Hjermstad MJ, Lie HC, Caraceni A, Currow DC, Fainsinger RL, Gundersen OE, et al. Computer-based symptom assessment is feasible in patients with advanced cancer: results from an international multicenter study, the EPCRC-CSA. J Pain Symptom Manag. 2012;44(5):639–54. CrossRef
Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson LE, Fisher K, et al. The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a Delphi process and patient think-aloud interviews. J Pain Symptom Manag. 2008;35(2):136–52. CrossRef
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23(2):129–38.
McGinn T, Wyer PC, Newman TB, Keitz S, Leipzig R, Guyatt G, The Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic). CMAJ. 2004;171(11):1369–73. https://doi.org/10.1503/cmaj.1031981. CrossRefPubMedPubMedCentral
Hjermstad MJ, Kaasa S, Caraceni A, Loge JH, Pedersen T, Haugen DF, et al. Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer. BMJ Support Palliat Care. 2016;6(3):344–52. CrossRef
Davies A, Dickman A, Farquhar-Smith P, Webber K, Zeppetella J. Letter to the Editor re ‘Characteristics of breakthrough cancer pain and its influence on quality of life in an international cohort of patients with cancer (BMJ Support Palliat Care 2016;6:344–52)’. BMJ Support Palliat Care. 2017;7(3):264. PubMed
Valeberg BT, Miaskowski C, Hanestad BR, Bjordal K, Paul S, Rustoen T. Demographic, clinical, and pain characteristics are associated with average pain severity groups in a sample of oncology outpatients. J Pain. 2008;9(10):873–82. CrossRef
Fainsinger RL, Fairchild A, Nekolaichuk C, Lawlor P, Lowe S, Hanson J. Is pain intensity a predictor of the complexity of cancer pain management? J Clin Oncol. 2009;27(4):585–90. CrossRef
Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M, et al. An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer. 2010;46(16):2896–904. CrossRef
Cardinal LJ. Central tendency and variability in biological systems. J Community Hosp Intern Med Perspect. 2015;5(3):27930. CrossRef
Johnson MJ, Currow DC. Minimal clinically important difference and Edmonton Symptom Assessment Scale. Cancer. 2016;122(1):158–9. CrossRef
Hui D, Bruera E. Reply to minimal clinically important difference and Edmonton Symptom Assessment Scale. Cancer. 2016;122(1):159–60. CrossRef
Hui D, Bruera E. The Edmonton symptom assessment system 25 years later: past, present, and future developments. J Pain Symptom Manag. 2017;53(3):630–43. CrossRef
Tripepi G, Jager KJ, Dekker FW, Zoccali C. Selection bias and information bias in clinical research. Nephron Clin Pract. 2010;115(2):c94–9. CrossRef
Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32(36):4149–54. CrossRef
Thronaes M, Raj SX, Brunelli C, Almberg SS, Vagnildhaug OM, Bruheim S, et al. Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart. Support Care Cancer. 2016;24(6):2565–74. CrossRef
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