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What Is Breakthrough Pain?

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Updated December 13, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Question: What Is Breakthrough Pain?
Answer:

Breakthrough pain is pain that comes on very quickly and may become so severe as to disable or immobilize you. Breakthrough pain can occur with back pain, cancer pain, neuropathic pain, and other types. In order for pain to be identified as breakthrough pain, persistent pain must first be present.

Almost all people with persistent back pain experience breakthrough pain.

Breakthrough Pain Symptoms

Studies show that breakthrough pain generally takes about 10 minutes to ramp up to full intensity, and that each episode lasts between 15 to 55 minutes, on average.

If you have nerve-related breakthrough pain, you may experience shorter, more frequent episodes. This pattern contributes to altered responses to pain and other stimuli in people with nerve pain. Examples of these altered responses include:

Breakthrough Pain Medications

Experts on breakthrough pain generally recommend to doctors that they tailor treatments to each individual patient. Breakthrough pain is most often treated with short-acting opioids (narcotics). Medication given for breakthrough pain is referred to as "rescue medication."

There are several types of breakthrough pain, so determining exactly which medication will address yours should be done in partnership with your doctor. Your doctor will need to know about you, your medical history, your back condition, and your recent pain. (Keeping a pain chart or diary will likely help you here.) Your doctor uses the information you give her about pattern, cause (if you have that information), intensity, and onset of your breakthrough pain to determine which type you have and to match a particular quick-acting opioid medication to it.

About 50-60% of breakthrough pain can be predicted, although that can range as much as 41-81%. If your breakthrough pain is the type that can be predicted, your doctor may anticipate it in advance and give you short-acting opioids. If your breakthrough pain cannot be predicted, it’s possible she may prescribe an entirely different type of medication. The choice of pain medication is based on the type of breakthrough pain you have.

Non-Drug and At-Home Treatments for Breakthrough Pain

Non-drug treatments may be integrated with opioids for breakthough pain. Your doctor may counsel you to limit your activity, to use ice or heat, or other at-home therapies. She may refer you to physical or massage therapy, or to a specialist for a nerve block. It is important to speak with your doctor directly about the best way to manage your breakthrough pain.

Sources:

Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain. Part 1: Assessment. Pharm Ther. 2005;30:296–301. http://www.pharmscope.com/ptjournal/fulltext/30/5/PTJ3005296.pdf

Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain. Part 2: Management. Accessed: Dec 2010. http://www.ptcommunity.com/ptjournal/fulltext/30/6/PTJ3006354.pdf

Devulder J, et. al. Impact of opioid rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic non-malignant pain. Br J Anaesth. 2009 Oct;103(4):576-85. Epub 2009 Sep 6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742451/?tool=pubmed

McCarberg BH., The treatment of breakthrough pain. Pain Med. 2007 Jan-Feb;8 Suppl 1:S8-13.http://www.ncbi.nlm.nih.gov/pubmed/17280601

Payne, R., MD, Colliflower, E., Recognition and Diagnosis of Breakthrough Pain. Pain Medicine. Vol. 8. Number S1. American Academy of Pain Medicine. Blackwell Publishing Inc. 2007. Accessed Dec 2010. http://www.fchs.ac.ae/fchs/uploads/Files/Semester%201%20-%202010-2011/3971/article%201a%20theme%207%20%20%20%20ContentServer.pdf

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