Evidence map›Paper›PMID 42622864›Full record

ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026

Inverse dose proportionality: using breakthrough pain medication as a biological indicator for background analgesia escalation.

Sebastiano Mercadante, Giuseppe Massimo Bellavia, Daniele Napolitano, Alessio Lo Cascio

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Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Sebastiano MercadanteMain Regional Center of Pain Relief and Supportive Care, La Maddalena Cancer Center, Palermo, Italy.
Giuseppe Massimo BellaviaRegional Home Care Program SAMOT, Palermo, Italy.
Daniele NapolitanoSITRA and Scientific Direction, Fondazione Policlinico Gemelli IRCCS, Rome, Italy. daniele.napolitano@policlinicogemelli.it.
Alessio Lo CascioClinical Trial Unit, La Maddalena Cancer Center, Palermo, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo propose a "top-down" pharmacological hypothesis where the effective dose of rapid-onset opioids (ROOs) for breakthrough pain (BTP) serves as a mathematical predictor for required background analgesic adjustments.

methodsWe analyzed five opioid-tolerant cancer patients in a home-care setting with uncontrolled background pain. Instead of traditional reactive titration, a 1:6 inverse proportionality rule was applied, using the patient-identified effective BTP dose to calculate the new around-the-clock (ATC) dose.

resultsRapid pain stabilization was achieved in patients within 24-48 h. Despite significant dose escalations (up to 300%), no clinical signs of opioid-induced neurotoxicity or respiratory depression were observed.

conclusionThe effective BTP dose may act as a "bio-indicator" of systemic opioid requirement. This hypothesis challenges the "start low, go slow" dogma, suggesting a more aggressive, patient-centered titration model that warrants formal prospective validation.

Indexed as

Analgesics, OpioidBreakthrough PainCancer PainAgedDose-Response Relationship, DrugDrug ToleranceFemaleHome Care ServicesHumansMaleMiddle AgedAnalgesics, OpioidBreakthrough painCancer painOpioidsPalliative care

Identifiers

PMID42622864

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.