Breakthrough pain Assessment Tool (BAT)

The following questions relate to your breakthrough pain over the last week. Breakthrough pain refers to the short-lived increases in your cancer pain.

QUESTION 1

Where is your breakthrough pain?

Indicate on the diagram below the places where you feel pain.

QUESTION 2

How often do you get breakthrough pain?

Please select one answer

QUESTION 3

Does anything bring on your breakthrough pain?

If yes, please write down

QUESTION 4

Does anything relieve your breakthrough pain? (painkillers or other)

If yes, please write down

QUESTION 5

How long does a typical episode of breakthrough pain last?

Please select one answer

QUESTION 6

How severe is your worst episode of breakthrough pain?

Please select one number

QUESTION 7

How severe is your typical episode of breakthrough pain?

Please select one number

The following questions relate to your breakthrough pain over the last week. Breakthrough pain refers to the short-lived increases in your cancer pain.

QUESTION 8

How much does the breakthrough pain distress you?

Please select one number

QUESTION 9

How much does the breakthrough pain stop you from living a normal life?

Please select one number

QUESTION 10

What painkillers do you take for your breakthrough pain (if any)?

Please write down type and dose of painkillers

QUESTION 11

How effective is the painkiller that you usually take for your breakthrough pain?

Please select one number

QUESTION 12

How long does the painkiller for your breakthrough pain take to have a meaningful effect?

Please select one answer

QUESTION 13

Do you get any side-effects from the painkiller for your breakthrough pain?

If yes, please write down type of side effect

QUESTION 14

How much do side-effects from the painkillers for your breakthrough pain bother you?

Please select one number