Copyright © 2012 Informa UK Limited Not for Sale or Commercial Distribution Unauthorized use prohibited. Authorised users can download, display, view and print a single copy for personal use Current Medical Research & Opinion Vol. 29, No. 1, 2013, 93–97 0300-7995 Article ST-0266.R1/755120 doi:10.1185/03007995.2012.755120 All rights reserved: reproduction in whole or part not permitted Brief report Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients Sebastiano Mercadante Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy Claudio Adile Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy Riccardo Torta Antonella Varetto Department of Psycho-Oncology, University of Turin, Turin, Italy Fabio Fulfaro Department of Oncology, University of Palermo, Palermo, Italy Antonino Giarratano Department of Anesthesia, Intensive Care & Emergencies, University of Palermo, Palermo, Italy Alessandra Casuccio Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy Address for correspondence: Prof. Sebastiano Mercadante, Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via san Lorenzo 312, 90145 Palermo, Italy. Tel.: þ39 091 6806521; Fax: þ39 0916806110; terapiadeldolore@lamaddalenanet.it; 03sebelle@gmail.com Keywords: Breakthrough pain – Cancer pain – Meaningful pain intensity – Palliative care Accepted: 29 November 2012; published online: 13 December 2012 Citation: Curr Med Res Opin 2013; 29:93–97 Abstract Objectives: To assess the level of pain intensity at which patients feel the impetus to ask for a breakthrough cancer pain (BTcP) medication, and level of pain intensity at which patients consider they have achieved acceptable pain control after receiving a BTcP medication. Methods: A consecutive sample of patients who were receiving oral morphine equivalents equal to or more than 60 mg daily, and were prescribed rapid onset opioids for the management of episodes of BTcP, were included in the study. Focused educational activities regarding BTcP and numerical scales were established during hospital admission. At discharge patients were interviewed to find out what was the pain intensity level which gave the impetus to take the BTcP medication, what was the pain intensity for acceptable pain control after a BTcP medication had been given, and which factors prevented the patient calling for BTcP medication. A brief COPE (coping orientation to problems experienced) questionnaire was also administered. Results: Fifty-two patients were recruited for this study. The meaningful pain intensity for asking for a BTcP medication was 7.1; 77% of patients had a pain intensity of 7–8 on a numerical scale of 0–10. The meaningful pain intensity for adequate analgesia after a BTcP medication was 3.5. Similarly, 77% of patients had a pain intensity of 3–4. There was no relationship with the variables examined. Concerns by patients about the use of BTcP medications were minimal. Conclusion: The meaningful BTcP intensity and pain intensity expected after BTcP medication can be useful in selecting patients in studies of BTcP. The principal limitation of this study was the specific setting of an acute unit with specific features and the relatively low number of patients. This observation should be followed up by further surveys with a larger number of patients and different settings. Introduction Breakthrough cancer pain (BTcP) has been defined as ‘‘a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific trigger, despite relatively stable and adequately controlled background pain’’ 1,2 . BTcP is often managed with opioids that are given in addition to regularly scheduled, around-the-clock analgesics. To evaluate the effects of an analgesic drug, pain intensity is commonly measured at intervals after the administration. The time to effective pain relief is a measure that has been recently used to better reflect the temporal ! 2013 Informa UK Ltd www.cmrojournal.com Cut-off pain intensity for BTcP in advanced cancer patients Mercadante et al. 93 Curr Med Res Opin Downloaded from informahealthcare.com by Prof Sebastiano Mercadante on 04/07/13 For personal use only.