Effective pain management is an essential component of the comprehensive care of patients with advanced cancer. Rhiner and von Gunten have written a review examining the roles the health-care practitioner and patient/family play in the undertreatment of breakthrough pain. The highlight of their article is a suggestion for a compelling new way to think about persistent and breakthrough cancer pain as distinct clinical entities. In addition, they identify technical, communication, behavioral, and regulatory barriers to effective evaluation and management. Because of these barriers, breakthrough cancer pain is often underappreciated and inadequately managed.

While the authors focus on the use of transmucosal fentanyl as the optimal opioid for addressing the challenges of breakthrough pain management, our experience suggests that all oral short-acting opioids are appropriate and effective. More important than the choice of opioid, all those who manage patients with cancer must be capable and committed to managing chronic and breakthrough cancer pain.

Breakthrough cancer pain is common. The phenomenon was first characterized by Portenoy and Hagen in 1990,¹ and its prevalence has been estimated in several studies and ranges from 19% to 95%.