Canadian recommendations for the management of breakthrough cancer pain

Breakthrough cancer pain (BTCP) represents an important element in the spectrum of cancer pain management. Because most BTCP episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of BTCP; however, there are no uniform national recommendations for the management of BTCP. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of BTCP. Currently, immediate-release oral opioids are the treatment of choice for BTCP. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of BTCP. Novel transmucosal fentanyl formulations might be more appropriate for some types of BTCP, but limited access to such drugs hinders their use. In addition, the recognition of BTCP and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of BTCP, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of BTCP and the alleviation of the suffering and discomfort experienced by adult cancer patients.