ABSTRACT
Breakthrough pain is a common heterogeneous phenomenon in cancer patients which is often undertreated. The intensity of cancer pain commonly fluctuates over time and challenges usual cancer pain management using the World Health Organization (WHO) analgesic “ladder.” As with cancer pain etiology, breakthrough pain (BTP) may be caused by the cancer or by the cancer treatment. BTP may also be due to a concurrent disorder that is unrelated to the patient's cancer. BTP assessment should include an evaluation of its interference with activities of daily living and quality of life. The choice of medication for BTP episodes needs to be appropriate for the postulated BTP mechanism and characteristics of the individual's BTP and guided by patient preference and medication availability. Depending on the pain mechanism, the use of nonopioid analgesic regimens will also improve baseline analgesia. Intermittent subcutaneous midazolam has been used for the temporary sedation of patients with pathological hip fractures and severe BTP.
