Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms

Kristina B Svendsen, Steen Andersen, Sigurdur Arnason, Staffan Arner, Harald Breivik, Tarja Heiskanen, Eija Kalso, Ulf E Kongsgaard, Per Sjogren, Peter Strang, Flemming W Bach, Troels S Jensen

Research output: Contribution to journalReview Articlepeer-review

Abstract

Breakthrough pain or transient worsening of pain in patients with an ongoing steady pain is a well known feature in cancer pain patients, but it is also seen in non-malignant pain conditions with involvement of nerves, muscles, bones or viscera. Continuous and intermittent pain seems to be a general feature of these different pain conditions, and this raises the possibility of one or several common mechanisms underlying breakthrough pain in malignant and non-malignant disorders. Although the mechanisms of spontaneous ongoing pain and intermittent flares of pain (BTP) may be difficult to separate, we suggest that peripheral and/or central sensitization (hyperexcitability) may play a major role in many causes of BTP. Mechanical stimuli (e.g. micro-fractures) changes in chemical environments and release of tumour growth factors may initiate sensitization both peripherally and centrally. It is suggested that sensitization could be the common denominator of BTP in malignant and non-malignant pain. (c) 2004 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.
Original languageEnglish
JournalEuropean Journal of Pain
Volume9
Pages (from-to)195-206
Number of pages12
ISSN1090-3801
DOIs
Publication statusPublished - 2005
MoE publication typeA2 Review article in a scientific journal

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