What is pain?
Pain is a feeling of discomfort. For people with cancer, pain can be caused by the cancer itself, treatments, testing, and non-cancer-related reasons like headaches, and joint or muscle aches.
There are two types of pain:
- Acute pain is temporary and is often caused by some type of injury to the body. For example, pain after surgery is acute pain. As the body heals, the pain will go away.
- Chronic pain, also called persistent pain, is pain that lasts for long periods of time.
No matter what type of pain you have, it is important that the pain is managed so that you can live your life. When not treated, pain can lead to fatigue, worry, and sadness. Proper treatment is needed. If your care provider is unsure of how to treat your pain, you should ask to be referred to a provider who specializes in managing pain.
What is breakthrough pain?
Breakthrough pain (BTP) is a type of pain that can be felt by someone who has chronic pain. It is a sudden flare of pain. This pain "breaks through" the long-acting medication being used to treat moderate to severe persistent (chronic) pain. Even if your chronic pain is well managed with medication, you can still have episodes of BTP.
The Facts About Breakthrough Pain
Most people treated for chronic pain will have breakthrough pain. BTP flares are often caused by the same reason you have chronic pain.
- Pain can change throughout the day. BTP is often hard to predict.
- BTP flares may be caused by a specific movement or function of the body, such as walking or swallowing. They can also happen for no reason at all.
- People may have BTP flares near the time they are due for their next dose of pain medication.
- BTP flares may vary in how long they last and how intense they are.
Treating Breakthrough Pain
Breakthrough pain is different from chronic pain and needs to be treated differently. The best treatment for BTP is often a strong, short-acting opioid medication that works quickly and lasts about as long as a BTP episode. In some cases, treatment of the cancer itself can relieve pain.
- BTP medication is taken on an as-needed basis. It works best when taken as soon as symptoms start. BTP treatment is prescribed along with long-acting medication that is used to treat chronic pain.
- Prescription pain medications have been developed and approved as breakthrough pain treatment. Some of these medications are fentanyl sublingual tablets, fentanyl buccal tablets, immediate release morphine, and immediate release oxycodone.
- In most cases, it is not helpful to treat BTP by increasing the dose of medication being used to treat chronic pain as this can lead to being over-medicated. It can also increase side effects such as constipation, sedation, and confusion.
- When deciding on treatment options for BTP, your healthcare provider will take into account how well your chronic pain is being managed and how many pain flares you have each day.
Breakthrough pain can affect your daily life and can interrupt your treatment plan. It is important for you to tell your care team about any changes in your pain. It can take time to find a treatment plan that will work best for you, so it is important to start the conversation as soon as your pain symptoms change.
Caraceni A et al. Guidelines for the Management of Breakthrough Pain in Patients with Cancer. Journal of the National Comprehensive Cancer Network. 2013.
National Cancer Institute. Cancer Pain (PDQ®) – Patient Version. 2020.
National Cancer Institute. Pain in People With Cancer. 2018.