People with cancer pain often notice that their pain changes throughout the day. Many people with chronic cancer pain (pain that lasts longer than 3 months) have 2 types of pain -- persistent pain and breakthrough pain. Persistent or continuous pain is usually controlled by pain medicines taken around the clock (on a regular schedule). Breakthrough pain is pain that is not controlled by the regular doses of pain medicines.
Breakthrough pain is a flare of pain that happens even though you are taking pain medicine regularly for persistent pain. It's called breakthrough pain because it "breaks through" the pain relief you get from the regular pain medicine schedule. Breakthrough pain may be different for each person, and the person usually cannot predict when it will happen. As a rule, it comes on quickly, lasts as long as an hour, and feels much like persistent pain except that it is more severe or intense. It may happen many times a day, even when the right dose of medicine is given for the chronic pain.
Breakthrough pain is shown in the picture above as spikes through the relief provided by the around-the-clock analgesic (pain medicine to treat persistent pain). Breakthrough pain varies in intensity and usually cannot be predicted.
Breakthrough pain usually has the same cause as persistent pain. It may be the cancer itself or it may be related to cancer treatment. Some people have breakthrough pain during a certain activity, like walking or dressing. For others, it happens unexpectedly without any clear cause.
Different ways to treat chronic and breakthrough pain
Treating chronic pain: Drugs used to treat chronic or persistent pain need to work for a long time. They are called long-acting or sustained-release drugs and are taken at regular times or around the clock. You take these pain medicines on a schedule -- even if you are not having pain at the time the medicine is due. By taking these drugs on a schedule, you can maintain a fairly constant level of pain relief through the day and night. These drugs may be given in the form of tablets or capsules taken every 8 to 12 hours or through a skin patch that is worn for several days. Again, these drugs are taken on a schedule and not just when you are in pain. The medicines used to treat chronic pain are long-acting drugs. They are slowly released into the body and keep pain at a lower level over a long period of time. Drugs for breakthrough pain are different.
Treating breakthrough pain: Breakthrough pain is best treated with pain medicines that work quickly and for a short period of time. They are usually taken as needed, which means that they should be used as soon as you notice breakthrough pain. These short-acting drugs (sometimes called rescue medicines) work faster than those used to manage constant pain. They also stay in your body for a shorter time and often cause fewer side effects.
You should take your short-acting medicine when you first notice pain so that it can start to work to relieve your pain. Do not let the pain build up and become too severe, because it will be much harder to get under control. Follow the directions given to you. If the usual dose does not relieve your breakthrough pain, or if you think you are having breakthrough pain too often, tell your doctor or nurse. They may need to adjust the dose or frequency of your regular pain medicine. You may also want to take a dose of your breakthrough medicine to prevent pain before it starts if you know that you are likely to have breakthrough pain during or after a certain activity.
Common questions about breakthrough pain
Why did my doctor prescribe 2 different opioid pain medicines?
Since chronic pain and breakthrough pain are different types of pain, they need different types of medicine. Chronic pain is usually treated with long-acting drugs that are taken regularly to prevent as much pain as possible. Medicines for chronic pain take some time to work, but help to control your pain for hours or even days. Breakthrough pain is treated with short-acting drugs that are taken only when you need them. Drugs used to treat breakthrough pain start working faster to control severe flare-ups of pain then get out of your system quickly. These 2 types of pain medicine work together to treat both your chronic pain and your breakthrough pain.
If I have breakthrough pain, does it mean that the pain medicine I am using regularly for my chronic pain is not working well?
No. Breakthrough pain is an intense flare-up of pain that is usually more severe than chronic pain. Remember, breakthrough pain is common in people with cancer pain. It can happen even when a person is taking the right dose of pain medicine on a regular schedule for their chronic pain.
Still, let your doctor or nurse know if you are having more breakthrough flare-ups and just how often you need your breakthrough medicine. Sometimes you may need a larger dose of your chronic pain medicine.
How can I be sure that I'm getting the right dose of breakthrough pain medicine?
Your breakthrough pain medicine should relieve most of your breakthrough pain without causing unacceptable side effects, such as extreme drowsiness. If your breakthrough pain medicine does not relieve your breakthrough pain or if you have breakthrough pain more than 4 times a day, contact your doctor or nurse. They may need to adjust your dose or type of pain medicines to help you get the best pain relief.
Can I take my chronic pain medicine and my breakthrough pain medicine at the same time during the day?
Yes, if you need to. You may have breakthrough pain just before or after taking your regular pain medicine. At such times, you should take your breakthrough pain medicine and keep taking your chronic pain medicine on schedule. Always follow the directions given to you by your doctor or nurse.
If you notice that you often have breakthrough pain right before your usual dose of chronic pain medicine, talk to your doctor or nurse. They may need to adjust the dose, timing, or frequency of your chronic pain medicine. If you have any questions about when to take either your chronic or breakthrough pain medicines, contact your doctor or nurse to discuss your pain medicine schedule.
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