Un contributo per migliorare la comprensione e il trattamento del dolore da cancro: il breakthroughpain. Semplice dolore, sintomo specifico, o altro ancora?

Summary. A contribute to improve understanding and management of cancer pain: the breakthrough pain. Just pain, specific symptom or something else? Breakthrough pain (BTP) is highly prevalent in chronic cancer patients. and normally needs rescue treatments with opioids when pain flares up. BTP should be defined as an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTP is a heterogeneous condition as episodes vary between individuals. BTP can be classified into two big distinct pictures: spontaneous-type and incident-type pain. Controversies exist about the definition and epidemiology of BTP, the pharmacological treatment options, drug dosing, and how to select the medications for BTP. Analgesics should be given ‘by the clock' rather than 'on demand'. However, the chronobiological parameters circadian pain rhythm, circadian efficacy of analgesics, and individual circadian need for analgesics are to be considered. It normally needs rescue treatments with opioids when pain flares up. An accurate and regular assessment of BTP with validated instruments and a multidisciplinary revision of its treatment are the cornerstones for its treatment.