Frequently Asked Questions about Breakthrough Pain
Click below for answers to these frequently asked questions about breakthrough pain:
What is breakthrough pain?
Chronic pain often has 2 parts: one is persistent pain and the other is breakthrough pain.
Chronic pain
Chronic pain is pain that lasts for more than 3 months.
Persistent pain (constant or around-the-clock pain)
If your pain lasts all day it is called persistent pain, and your doctor can give you an around-the-clock opioid pain medicine that should work throughout the day.
Breakthrough pain
Even if your around-the-clock opioid medicine controls your persistent pain most of the time, you may still experience 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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Why is it important to treat breakthrough pain?
Breakthrough pain can strike suddenly and without warning in many cases. The pain can become severe in minutes.
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How do I know if I have breakthrough pain?
It is important to talk to your doctor about the pain you experience. Your doctor can help you use a pain assessment form or tool, such as our Personal Pain Assessment, to differentiate persistent pain from breakthrough pain. It may also be helpful to use a Daily Pain Journal, to keep track of your pain and the medicine you take to get relief. After you make notes in your journal, you should bring it to your doctor so you can work together to treat your pain better.
Identifying different types of pain can be difficult. The first step is to understand the different terms for pain. Chronic pain, or pain that lasts more than 3 months, often has 2 parts: persistent pain and breakthrough pain. Persistent pain is relatively constant, or around the clock. Breakthrough pain occurs when moderate-to-severe pain "breaks through" the medicine taken for all-day pain. Breakthrough pain episodes usually come on fast, peaking in as little as 3 minutes. Other episodes may escalate more slowly. 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 for the persistent pain.
Breakthrough pain may be predictable, meaning it occurs during a particular activity, like getting out of bed, going for a walk, or even breathing; or it may be spontaneous, occurring unexpectedly, while just sitting in a chair and reading, for example. It may also occur before a scheduled dose of around-the-clock pain medication.
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How can I communicate better with my doctor?
When communicating with your doctor, it is important that you give details about the breakthrough pain you experience. You may want to describe:
- Where you feel pain
- What it feels like — sharp, throbbing, steady
- How strong the pain feels
- What eases the pain, and what makes the pain worse
- How quickly it comes on and how long it lasts
- What medicines you are taking for the pain and how much relief you get from them
- How long it takes for your pain medication to provide relief
- What medicines you have taken previously
- What side effects have you experienced
To improve communication with your doctor, and ultimately improve your treatment plan, you will want to come prepared for your appointments. Dr. Liza Leal, a pain management specialist, recommends making a list of questions and keeping a Daily Pain Journal. You may also want to bring a friend or family member to help take notes or contribute to the conversation.
Click here to watch a video with Dr. Leal about preparing for your doctor visit.
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How do I describe my pain to my doctor?
The first step in developing a plan to treat your breakthrough pain is to talk with your doctor about what you are experiencing. When describing breakthrough pain, many patients use terms such as these:
- Hot
- Sharp
- Piercing
- Shooting
- Cutting
- Stabbing
- Burning
- Aching
- Throbbing
- Crawling under the skin
- Steady
You may find it helpful to keep a journal so you can write down what your pain feels like at different points during the day, and how long it takes for your medication to control your pain. You should bring your pain journal to your doctor so the two of you can discuss how to best manage your pain.
Click here to download your own Daily Pain Journal.
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What kind of goals should I set with my doctor?
While you may not experience complete relief from your pain, you and your doctor should be able to develop a realistic plan to manage the breakthrough pain you experience. Talk to your doctor about the best ways to manage your breakthrough pain.
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What can I do to help my doctor manage my pain?
First of all, make sure you are prepared for your doctor appointments. Dr. Liza Leal recommends familiarizing yourself with cancer pain terms, using a Daily Pain Journal to record what has happened since your last visit, making a list of questions to ask your doctor, and taking notes during your appointment. Click here to watch a video with Dr. Leal about preparing for your doctor visit.
Additionally, it is important that you keep a positive attitude. Chronic pain can have a profound effect on a person's life, but it may be possible, with the right behavior and the right attitude, to learn to cope with your pain.
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Where can I find support?
If you feel anxious or depressed, your pain may seem worse. Also, pain can cause you to feel worried, depressed, or easily discouraged. Some people feel hopeless or helpless. Others may feel embarrassed, inadequate, angry, frightened, isolated or frantic.
It is important that you try to talk about your feelings with someone you trust — doctors, nurses, social workers, family or friends, or other people with chronic pain. You may also wish to talk to a counselor or mental health professional. Your doctor, nurse, or the social services department at your local hospital can help you find a counselor who is specially trained to help people with chronic illnesses.
There are also resources available online. It may help to empower yourself with knowledge by visiting websites offering information about cancer and managing breakthrough pain.
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How can my friends and family help?
Your friends and family can be great sources of support. Talking with them about what you are experiencing may help you feel less alone, and may help them understand that your pain is real and requires medicine. You may want to bring friends or family members to your doctor visits. They may be able to take notes for you, or contribute to the conversation when you are telling your doctor about your pain and treatment effects.
Click here to watch a video with Dr. Leal about preparing for your doctor visit.
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What is the difference between addiction, physical dependence and tolerance?
When taking medicines for pain, you should be aware of possible long-term side effects or conditions such as addiction, physical dependence and tolerance, as well as the differences between them.
- Abuse: Frequent or persistent intentional, excessive drug use which is accompanied by harmful physical or psychological effect.
- Addiction: Characterized by one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving of a medicine. Addiction usually does not occur when you take medicine under your doctor's supervision
- Diversion: Intentional transfer of a drug from a legitimate source (i.e., distribution from a manufacturer, or storage in hospitals, pharmacies and doctors' offices) and/or from a patient for whom the drug has been prescribed, to unauthorized users and/or for illegal sale
- Overdose: Ingestion of more than the normal or recommended amount of something, usually a drug. An overdose may result in serious, harmful symptoms or death and may be the result of accidental or intentional exposure to a drug
- Pseudoaddiction: "Drug-seeking" behavior caused by not receiving enough pain medicine. This can be mistaken for addiction. It is NOT addiction. If you feel you are not taking enough medicine to relieve your pain, talk to your doctor
- Physical dependence: When your body has gotten used to having the drug in your system. If you suddenly stopped, you would feel sick. This is called withdrawal syndrome. If opioids are used for a long period of time, it is expected that you will become physically dependent on your medicine
- Tolerance: When the body gets used to the medicine and its effects. It may mean a stronger amount of medicine is needed to maintain pain relief. It can also be when the body gets used to some of the side effects, such as nausea. This means that over time you will not feel these side effects or the side effects will be less bothersome to you. Tolerance is NOT addiction
- Pseudotolerance: Similar to tolerance, this is when your body needs more medicine to continue feeling pain relief. More medicine is needed because the original cause of pain has progressed, a new cause is present, or because of increased activity and not because your body has adjusted to 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.