Breakthrough cancer pain

Many people with chronic cancer-related pain experience intermittent flares of pain that can occur even though a person is taking analgesic medications on a fixed schedule for pain control. These severe flares of pain are called breakthrough pain because the pain "breaks through" the regular pain medication. About one-half to two thirds of patients with chronic cancer-related pain also experience episodes of breakthrough cancer pain (Portenoy RK and Hagen NA, Pain 1990;41:273-281). . If you take a prescription pain medicine for cancer pain on a fixed schedule and you also have occasional flares of intense pain, you may be experiencing breakthrough cancer pain.

Almost all people experiencing chronic cancer pain should receive pain medications for around-the- clock pain control AND a medication specificallyfor treatment of breakthrough pain. If this has not been offered to you, discuss this with your health care provider.

The characteristics of breakthrough cancer pain vary from person to person, including the duration of the breakthrough episode and possible causes. Generally, breakthrough pain happens fast, and may last anywhere from seconds to minutes to hours. The average duration of breakthrough pain in one study was 30 minutes (Portenoy RK and Hagen NA, Pain 1990;41:273-281). . This kind of pain can happen unexpectedly for no obvious reason, or it may be triggered by a specific activity, like coughing, moving, or going to the bathroom. Most people who have breakthrough cancer pain experience several episodes a day.

If you are consistently experiencing pain just before it is time to take your next dose of medication as part of your around-the-clock pain management plan, this is not true "breakthrough pain," but rather an indication that the dose of the fixed-schedule medication needs to be adjusted.

The ideal medication for breakthrough cancer pain should be easily administered, work rapidly, and be excreted from the body within a relatively short period of time (Simmonds MA. Oncology. August 1999). . Most of these medications are opioids. The route of administration is important to consider; most people prefer oral medications (that can be taken by mouth) but these are not always fast-acting. Also, some people may not be able to take an oral drug due to difficulty in swallowing, nausea or other gastrointestinal problems. Breakthrough pain medications can be taken in other ways, including by injection, under the tongue (sublingual), rectally, or transmucosally absorbed in the mouth but not swallowed.

A new transmucosal drug for the treatment of breakthrough pain is now available. Called ACTIQ (Oral Transmucosal Fentanyl Citrate), it is the only analgesic drug to be approved by the Food and Drug Administration specifically for breakthrough pain, and the first analgesic medication that comes in the form of a lozenge on a handle. ACTIQ dissolves through the mucus membranes in the mouth and provides rapid pain relief within 5 to 10 minutes. If one dose is not sufficient for good pain control, discuss taking a second dose with your health care provider. Studies show that people find the drug easy to use, effective, and they tolerate it well. Other opioid medications, notably oxycodone and hydromorphone, can also be used for breakthrough pain, although these medications are not available as lozenges.

Cognitive techniques, including relaxation training, hypnosis, imagery, and distraction may also help relieve breakthrough pain for some people; see the section on Alternative/Complementary Therapy .