Pain is a common symptom of cancer. It has a prevalence of up to 90 per cent in patients with advanced disease. It is also probably the most feared of all cancer symptoms, with patients believing it is a sign that their condition has deteriorated. Background pain (also referred to as baseline or persistent pain) can, in most cases, be treated successfully with the use of long-acting opioid formulations and adjuvant drugs such as gabapentin, pregabalin or amitriptyline (see PJ, 9 and 23 June 2007, pp679-82 and pp745-8). However, despite well controlled background pain, cancer patients can experience pain of fast onset and short duration that can occur either predictably or spontaneously. This is referred to as breakthrough pain.
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