A Systematic Review of Measures of Breakthrough Pain and Their Psychometric Properties

• Published in: Journal of pain and symptom management Vol. 62; no. 5; pp. 1041 - 1064
• Main Authors: Liossi, Christina, Greenfield, Katie, Schoth, Daniel E, Mott, Christine, Jassal, Satbir, Fraser, Lorna K, Rajapakse, Dilini, Howard, Richard F, Johnson, Margaret, Anderson, Anna-Karenia, Harrop, Emily
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Breakthrough pain; Cancer; Children; COSMIN guidelines; Measurement; measurement properties; Pain; pain assessment; patient-reported outcome measures (PROMs); pediatric; Quantitative psychology; Self report; Systematic review; Breakthrough pain; pain assessment; measurement properties; patient-reported outcome measures (PROMs); COSMIN guidelines; pediatric; Pain assessment; Pediatric; Patient-reported outcome measures (PROMs); Measurement properties
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.04.018

Breakthrough pain (BTP) is common in cancer and other conditions yet there is a lack of validated BTP measurement tools. We aimed to identify all tools assessing or characterising BTP in patients of any age with any condition, and to critically appraise their psychometric properties. The Cochrane Library, PROSPERO, Embase, CINAHL, Medline, PsycINFO, Web of Science, Google Scholar, ProQuest, Evidence Search and OpenGrey were searched to identify all available tools used to assess BTP. A second search identified studies that had evaluated psychometric properties of tools identified in Search 1. Databases were searched from inception to November 2020. Studies were assessed using COSMIN criteria and GRADE guidelines. Search 1 found 51 tools used to assess BTP. Search 2 found six tools that had a development study and/or a study evaluating a tool psychometric property. No tool had more than one study evaluating psychometric properties so a meta-analysis could not be conducted. Studies were of inadequate to very good quality. Only the Breakthrough Pain Assessment Tool (BAT) had sufficient content validity and at least low-quality evidence for sufficient internal consistency. The BAT is recommended to characterise BTP in adults with cancer; its applicability to other conditions is unknown. The remaining tools need further evaluation. Only the Breakthrough Pain Questionnaire for Children was designed for children with cancer, but no psychometric properties were evaluated. There is a need for a tool to assess and characterise BTP in children with non-cancer diagnoses and those who cannot self-report.