The EONS Breakthrough Cancer Pain Guidelines

How and why were the Guidelines originally developed?

Picture of Breakthrough Cancer Pain documents

The Breakthrough Cancer Pain Initiative was a nurse-driven initiative launched with the purpose of improving breakthrough pain management in cancer patients. Patient surveys demonstrated that breakthrough cancer pain was under-recognised, sub-optimally treated and therefore subject of intense patient discomfort.

Oncology nurses have an important role in identifying and managing breakthrough cancer pain and in referring difficult cases to pain specialists. The Breakthrough Cancer Pain Initiative looked into the general understanding of breakthrough cancer pain amongst oncology nurses, confidence in treating these episodes, examples of best practice as well as gaps in current practice.

What die the Breakthrough Cancer Pain Initiative involve?

A European working group of oncology nurses drove the Breakthrough Cancer Pain Initiative. The working group consisted of:

  • Jenske Geerling, The Netherlands (guideline lead)
  • Theodora Pappa, Greece
  • Carina Rundström, Sweden
  • Prof. Tone Rustøen, Norway
  • Isolde Weisse, Germany
  • Sian Williams, United Kingdom
  • Bostjan Zavratnik, Slovenia

A multidisciplinary advisory group was formed to provide expert advice based on their knowledge within palliative care in general and Breakthrough Cancer Pain in particular. The advisory group members were:

  • Dr Andrew Davies, United Kingdom
  • Prof. Stein Kaasa, Norway
  • Dr Barry Quinn, United Kingdom (booklet lead)
  • Prof. Yvonne Wengstrøm, Sweden

Working group activities

Breakthrough cancer pain survey

A survey was carried out amongst oncology nurses in the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Norway, Slovenia, Sweden, The Netherlands and United Kingdom. The survey demonstrated an unmet educational need and a link between lack of training and/or assessment tools and the ability to distinguish breakthrough cancer pain from background pain and the nurses’ confidence in advising patients about breakthrough cancer pain.

The survey results were presented at the European Multidisciplinary Cancer Congress (EMCC) in Stockholm 24 September 2011. Download the presentation and see the webcast in the Further information section on the right.

EONS Breakthrough Cancer Pain guideline

Guidelines cover page

The working group developed a set of nurse-specific evidence- and practice-based guidelines on breakthrough cancer pain management. The guidelines reflected the findings of the above-mentioned survey and were the first to address breakthrough cancer pain management from a nurse perspective.

The objective of the guidelines was to provide guidance on assessment, identification and treatment of breakthrough cancer pain; they now serve as a platform to implement nurse-specific training programs. The specific targets and aims of the guidelines continue to be to:

  • Increase nurses' knowledge of specific elements of breakthrough cancer pain
  • Causes for breakthrough cancer pain
  • Features and symptoms of breakthrough cancer pain
  • Differences between end of dose pain and transitory breakthrough cancer pain
  • Consequences of breakthrough cancer pain
  • Treatment measures
  • Support nurses to assess and identify breakthrough cancer pain
  • Encourage successful management of breakthrough cancer pain
  • Update and inform nurses of the current guidelines based on previously published evidence

The breakthrough cancer pain guidelines are published in the Further Information column on this right of page. In addition, a complementary pocket guide was developed and piloted during the pain management workshop at the EAPC Congress in Prague in 2013. This pocket guide is also published here.
+  Read the guidelines
+  Read the pocket guide

The guidelines were also presented at The European Multidisciplinary Cancer Congress. Download the presentation and see the webcast in the Further information section on the right..

The guidelines were launched at a training workshop during the European Cancer Congress in Amsterdam in September 2013.

More information

Please contact Rudi Briké at the EONS Secretariat with any questions or to request further information. You may do this directly from the contact EONS page.


Phase I of this work (survey) was supported by an educational grant provided by Nycomed.

Phase II of this work (guideline and booklet) was supported by an educational grant provided by Takeda.

Phase III of this work (workshops at EMCC and EAPC) was supported by an educational grant provided by Takeda.

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