Breakthrough Pain

Author: OncoLink Team
Last Reviewed:

What is pain?

Pain is any type of uncomfortable feeling. In the cancer population pain can be caused by the cancer itself, treatments, testing, and non-cancer related reasons such as headaches and joint and muscle aches and pains. There are two types of pain: acute and chronic.

  • Acute pain is temporary and 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 appropriately 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 pain specialist.

What is breakthrough pain?

Breakthrough pain (BTP) is a type of pain that can be experienced by someone who has chronic pain. It is a sudden flare of pain that "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. Breakthrough pain flares are often caused by the same reason you have chronic pain.

  • Pain can change throughout the day. Breakthrough pain episodes are unpredictable.
  • Breakthrough pain flares may be a result of a specific movement or function of the body such as walking or swallowing. They can also occur for no reason at all.
  • People may have breakthrough pain flares near the time they are due for their next dose of pain medication.
  • Breakthrough pain flares may vary in length and intensity.

Treating Breakthrough Pain

Breakthrough pain is different from chronic pain and requires different treatment. Usually the best treatment for breakthrough pain is a strong, short-acting opioid medication that works quickly and lasts about as long as a breakthrough pain episode. In some cases, treatment of the cancer itself can relieve pain.

  • Breakthrough pain medication is taken on an as-needed basis. It works best when taken as soon as symptoms start. Breakthrough pain treatment is prescribed in addition to long-acting medication (usually an opioid) taken around-the-clock to treat chronic pain.
  • Specific prescription pain medications have been developed, and approved as breakthrough pain treatment. Some of these medications include fentanyl sublingual tablets, fentanyl buccal tablets, immediate release morphine and immediate release oxycodone
  • In most cases it is not helpful to treat breakthrough pain by increasing the dose of medication being used to treat chronic pain as this can result in being over medicated. It can also increase side effects such as constipation, sedation, and confusion.
  • When deciding on treatment options for breakthrough pain your healthcare provider will take into account how well the chronic pain is being managed and the number of and intensity of pain flares each day.

Breakthrough pain can interfere with daily activities 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 early. 

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