Development and validation of the breakthrough pain assessment tool (BAT) in cancer patients

J Pain Symptom Manage. 2014 Oct;48(4):619-31. doi: 10.1016/j.jpainsymman.2013.10.026. Epub 2014 Apr 22.


Context: The successful management of breakthrough pain depends on a combination of adequate assessment, appropriate (individualized) treatment, and adequate re-assessment. Currently, there is no fully validated clinical assessment tool for breakthrough pain in cancer patients.

Objectives: The aim of this project was to develop and validate a breakthrough pain assessment tool (the BAT) for use in the clinical setting.

Methods: The content of the BAT was determined by reviewing the medical literature, conducting a Delphi process with experts in breakthrough pain and/or pain assessment and conducting semi-structured interviews with cancer patients with breakthrough pain. The tool was then subjected to a series of standard psychometric tests to assess its factor structure, validity (i.e., content validity, construct validity), reliability (i.e., internal consistency, test-retest reliability), and responsiveness to change.

Results: The BAT comprised two pages with 14 questions. Factor analysis confirmed the presence of two underlying factors. Psychometric testing confirmed that the tool is valid, reliable, and responsive to change.

Conclusion: This study provides initial evidence for the validity and reliability of the breakthrough pain assessment tool which may be used to facilitate the management of patients with breakthrough cancer pain in the clinical setting.

Keywords: Breakthrough pain; cancer; episodic pain; pain assessment.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breakthrough Pain / diagnosis*
  • Breakthrough Pain / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neoplasms / diagnosis
  • Neuropsychological Tests*
  • Pain Measurement / methods*
  • Psychometrics / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Surveys and Questionnaires*