Mercadante, S., Villari, P., Ferrera, P., Mangione, S., & Casuccio, A. (2010). The use of opioids for breakthrough pain in acute palliative care unit by using doses proportional to opioid basal regimen. The Clinical Journal of Pain, 26(4), 306–309.

To determine the efficacy and safety of different opioids, used in doses proportional to basal opioid regimen, for the management of breakthrough pain (BTP)

The choice of opioids was based on clinical judgment. BTP dose was calculated at 20% of the daily dose. Opioids for BTP included IV morphine, oral transmucosal fentanyl citrate (OFTC), oral morphine, IV methadone, oral methadone, and oral oxycodone. Assessment was of pain intensity (PI) at baseline and at 15 minutes after administration.

• The sample was composed of 66 patients and involved 503 episodes of BTP.
• Mean patient age was 66.7 years (SD = 12.2 years).
• The sample included 24 females and 42 males.
• Authors did not include information about diagnoses.
• Patients had been admitted to a pain relief and palliative care unit and were receiving opioids equivalent to morphine 60 mg/day or more.

• Single site
• Inpatient
• Italy

Prospective descriptive study

Verbal rating scale, 0–10 points

• Patients experienced a mean of 8.7 BTP episodes during hospitalization—a median of 2/day.
• Of 503 episodes of BTP, 427 were treated without making a further request for pain control; 76 patients (15%) required an additional BTP dose within two hours.
• IV morphine and OTFC were administered most frequently. In 99.2% of patients, IV morphine resulted in a decrease in pain intensity of greater than 33%. In 97.6% of patients, OTFC resulted in a decrease in pain intensity of greater than 97.6%.
• No adverse effects were severe enough to require intervention.

Administration of 20% of the basal dose was effective in controlling BTP.

• The study had a small sample size, with fewer than 100 patients.
• The sample was a convenience sample.
• Patients were not blinded to intervention.
• Patients were in one unit only.
• The study comprised various opioids.

Results support mathematical calculation of the BTP dose to control BTP adequately. Nurses working in pain management and palliative care should be educated regarding equianalgesic conversion methods.