Breakthrough Pain

Author: Marisa Healy, BSN, RN
Content Contributor: Allyson Distel, MPH
Last Reviewed: January 24, 2024

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, the pain should be managed so that you can live your life. When not treated, pain can lead to fatigue (feeling tired), 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 onset of pain. This pain "breaks through" the long-acting medication being used to treat your chronic pain. Even if your chronic pain is well managed with medication, you can still have BTP.

The Facts About Breakthrough Pain

Most people treated for chronic pain will have breakthrough pain. BTP is often caused by the same reason you have chronic pain.

  • Pain can change throughout the day. You often don’t know when BTP will happen.
  • BTP may be caused by moving your body a certain way, such as walking or swallowing. It can also happen for no reason at all.
  • People may have BTP around the time they are to take their next dose of pain medication.
  • BTP varies in how long and intense it is.

Treating Breakthrough Pain

Breakthrough pain is not 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 flare-up. 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 a 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 worsen side effects such as constipation, sedation, and confusion.
  • When deciding on treatment options for BTP, your healthcare provider will consider how well your chronic pain is being managed and how often you have BTP each day.

Breakthrough pain can affect your daily life and interrupt your treatment plan.  It can take time to find a treatment plan that will work best for you, so you should tell your provider as soon as your pain symptoms change.