Understanding Breakthrough Pain in Opioid Tolerant Patients with Cancer
Chronic pain often has 2 parts: one is persistent pain and the other is breakthrough pain.
What is chronic pain?
Chronic pain is pain that lasts for more than 3 months.
What is persistent pain?
If your pain lasts all day it is called persistent pain, and your doctor can give you a daily around-the-clock opioid pain medicine that should work throughout the day.
What is breakthrough pain?
Even if your around-the-clock opioid medicine controls your persistent pain most of the time, you can still have sudden flares of moderate-to-severe pain. This is breakthrough pain — pain that "breaks through" your around-the-clock medicine.
Breakthrough pain is commonly associated with sudden onset. It is an intense flare or spike of pain on top of otherwise stable pain.
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Types of breakthrough pain
Breakthrough pain occurs when moderate-to-severe pain "breaks through" your around-the-clock opioid pain medicine. Episodes may last from a few minutes to an hour or more, and may occur several times a day, even when the proper dose of medicine is given to treat the all-day (persistent) pain.
Breakthrough pain can occur during everyday activities, such as getting out of bed, taking a walk, or coughing. It may occur without a specific cause or reason — your doctor may call this spontaneous breakthrough pain.
This chart may help you understand how breakthrough pain is often classified:
Activity Related (predictable/ unpredictable)
This is breakthrough pain that occurs during a particular activity, like getting dressed in the morning or even breathing. It is important to remember that even when your breakthrough pain is predictable, you may not be able to foresee the timing of the onset or the severity of the pain.
Spontaneous
This type of breakthrough pain happens unexpectedly, like when you're just sitting in a chair reading, and it has no readily identifiable cause.
End-of-dose
This type of breakthrough pain may occur before taking a scheduled dose of around-the-clock pain medication.
Talk to your doctor about the types of breakthrough pain you experience so you can work together to determine the best treatment approach.
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Describing breakthrough pain in patients with cancer
If you are experiencing breakthrough pain, the first step in developing a treatment plan is to talk with your doctor or nurse about what you are experiencing. This means you will need to be able to describe your pain as well as you can.
Common terms used to describe breakthrough pain
Here is a list of terms that many pain patients may use when describing their breakthrough pain. This may be helpful to you when talking to your family members and healthcare team.
- Hot
- Sharp
- Piercing
- Shooting
- Cutting
- Stabbing
- Burning
- Aching
- Throbbing
- Crawling under the skin
You may find it helpful to use a journal to keep track of your pain and the medicine you take to get relief. After you make notes in the journal, you should bring it to your doctor so you can work together to treat your pain better. Each day, consider writing down the following information:
- Where the pain occurs on your body, and any words you can use to describe it
- What medicines you are taking
- The dosages of your medicines
- The time you take your medicines
- How long before your medication starts to work
- How bad the pain is before and after you take the medicine
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IMPORTANT:
- DO NOT USE FENTORA unless you are regularly using other opioid pain medicines around-the-clock for your constant cancer pain and your body is used to these medicines.
- Keep FENTORA in a safe place away from children. Accidental use by a child is a medical emergency and can result in death. If a child accidentally takes FENTORA, get emergency help right away.
Read the Medication Guide that comes with FENTORA before you start taking it and each time you get a new prescription. There may be new information. This Medication Guide does not take the place of talking to your doctor about your medical condition or your treatment. Share this important information with members of your household.
The most important information you should know about FENTORA is:
- FENTORA can cause life-threatening breathing problems which can lead to death:
- If you are not regularly using other opioid pain medicines around-the-clock for your constant cancer pain and your body is not used to these medicines. This means that you are not opioid tolerant
- If you do not use it exactly as prescribed by your doctor
- Your doctor will prescribe a starting dose of FENTORA that is different than other fentanyl containing medicines you may have been taking. Do not substitute FENTORA for other fentanyl medicines, including Actiq®, without talking with your doctor.