Review 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 Andrew N. Daviesa, Andrew Dickmanb, Colette Reidc, Anna-Marie Stevensd and Giovambattista Zeppetellae aRoyal Marsden NHS Foundation Trust, Department of Palliative Medicine, Downs Road, Sutton SM2 5PT, United Kingdom bMarie Curie Palliative Care Institute, Liverpool, United Kingdom cGloucestershire Hospitals NHS Trust, United Kingdom dRoyal Marsden NHS Foundation Trust, London, United Kingdom eSt. Clare Hospice, Hastingwood, United Kingdom Abstract A task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) was convened to produce some up-to-date, evidence-based, practical, clinical guidelines on the management of cancer-related breakthrough pain in adults. On the basis of a review of the literature, the task group was unable to make recommendations about any individual interventions, but was able to make a series of 12 recommendations about certain generic strategies. However, most of the aforementioned recommendations are based on limited evidence (i.e., case series, expert opinion). The task group also proposed a definition of breakthrough pain, and some diagnostic criteria for breakthrough pain. Recommendations 3.1. Patients with pain should be assessed for the presence of breakthrough pain (grade of recommendation – D) 3.2. Patients with breakthrough pain should have this pain specifically assessed (D) 3.3. The management of breakthrough pain should be individualised (D) 3.4. Consideration should be given to treatment of the underlying cause of the pain (D) 3.5. Consideration should be given to avoidance/treatment of the precipitating factors of the pain (D) 3.6. Consideration should be given to modification of the background analgesic regimen/“around the clock medication” (D) 3.7. Opioids are the “rescue medication” of choice in the management of breakthrough pain episodes (D) 3.8. The dose of opioid “rescue medication” should be determined by individual titration (B) 3.9. Non-pharmacological methods may be useful in the management of breakthrough pain episodes (D) 3.10. Non-opioid analgesics may be useful in the management of breakthrough pain episodes (D) 3.11. Interventional techniques may be useful in the management of breakthrough pain (D) 3.12. Patients with breakthrough pain should have this pain specifically re-assessed (D) Ann's NOTE: We asked the researcher to explain the grades for us - that is pending. European Journal of Pain, August 2008 doi:10.1016/j.ejpain.2008.06.014 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.