Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Adv Ther. 2017 Jan;34(1):120-135. doi: 10.1007/s12325-016-0440-4. Epub 2016 Nov 21.


Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.

Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.

Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.

Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients' satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.

Funding: Molteni Farmaceutici, Italy.

Keywords: Breakthrough pain; Cancer pain; Pain assessment; Rapid-onset opioid.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Analgesics, Opioid / therapeutic use*
  • Breakthrough Pain / diagnosis
  • Breakthrough Pain / drug therapy*
  • Breakthrough Pain / therapy
  • Cancer Pain / diagnosis
  • Cancer Pain / drug therapy*
  • Cancer Pain / epidemiology
  • Cancer Pain / therapy
  • Female
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pain Management / methods*
  • Pain Measurement
  • Patient Satisfaction
  • Surveys and Questionnaires


  • Analgesics, Opioid