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Breakthrough Pain

Overview

Breakthrough pain is a sudden and brief flare-up of pain from a chronic condition like arthritis or cancer. Even if you’ve been managing your pain with medication, during this flare-up the pain becomes severe enough to “break through” the pain medication you’re taking.

Sometimes breakthrough pain has an obvious trigger. For example, if you have arthritis in your wrists and you play tennis, you could set off your pain by swinging the racket. In other cases, breakthrough pain attacks are unpredictable and come on without warning. People who have cancer sometimes experience periods of pain while they’re taking opioid pain relievers.

About of Americans who live with chronic pain conditions have episodes of breakthrough pain. These episodes come on suddenly, and they typically last about . The pain may strike only on occasion, or as often as .

Breakthrough pain can be managed by changing your medication, avoiding your triggers, and trying alternative pain relief techniques.

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Causes and triggers

Causes and triggers

Breakthrough pain affects people with chronic pain conditions. It’s common in people with cancer, but it can also occur in those with:

Episodes of breakthrough pain often start unexpectedly. The pain can be triggered by something as seemingly harmless as a cough or sneeze.

Other possible causes of breakthrough pain include:

  • stress
  • illness
  • walking and other forms of exercise

Sometimes you can get breakthrough pain if you become tolerant to the pain medications you take. Tolerance means you need to take an increasingly higher dose of the medication to get the same pain relief. You can also get breakthrough pain if the effects of your pain medication start to wear off before it’s time for you to take the next dose.

Sometimes breakthrough pain doesn’t have any obvious trigger.

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Medication and dosage

Medication and dosage

Before you can treat breakthrough pain, you need to make sure your chronic pain is well managed. Moderate pain may be managed with prescription strength non-narcotic medications such as non-steroidal anti-inflammatory drugs or acetaminophen. More severe chronic pain is treated with an extended-release opioid that lasts for 8 to 12 hours.

See your doctor or pain specialist if the long-term medication you take isn’t adequately controlling your pain. You might need to increase the dose, add another pain reliever, or incorporate other treatments.

To help your doctor better understand the pain you’re experiencing, keep a record of your breakthrough pain episodes in a pain diary. Write down when the pain starts, how long it lasts, and what triggers it.

To treat episodes of breakthrough pain, you can take a “rescue medication.” This means a pain reliever that goes to work quickly and lasts for a short period of time. Usually breakthrough pain is treated with a short-acting opioid that is of the dose you normally take to manage chronic pain. You’ll take this pain reliever right when your symptoms start.

One commonly used fast-acting opioid for breakthrough pain is the narcotic fentanyl citrate. It comes as a “lollipop” that absorbs through the lining of your cheek. Fentanyl also comes in a tablet that dissolves under your tongue, as a patch, and as a nasal spray.

Your doctor should tailor your breakthrough pain medication and dose to you. Because your pain can evolve over time, check back in with your doctor periodically to see if you need to adjust your pain medication regimen.

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Prevention

Preventing a flare

One effective way to prevent breakthrough pain is to avoid anything that you know triggers it.

If you have arthritis and typing on a keyboard aggravates your wrist pain, use an ergonomic keyboard or voice recognition software, or wear a wrist brace. If coughing causes your pain to spike, take a cough suppressant. If activity sets off your pain, you may need to alternate periods of exercise with rest.

You can also try these alternative pain-relieving techniques to both prevent and manage breakthrough pain:

If you have cancer, breakthrough pain could be a sign that your disease has progressed. You might need surgery, radiation, chemotherapy, or other treatments to shrink the tumor and relieve your pain.

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Complications

Complications

Breakthrough pain can cause a lot of anxiety and distress. It can interfere with your routine and may negatively impact your quality of life.

Complications of breakthrough pain include:

  • decreased mobility, which can lead to weak muscles, stiff joints, pressure sores, constipation, pneumonia, and blood clots
  • depression and anxiety
  • loneliness
  • more frequent doctor and hospital visits
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Outlook

Outlook

Breakthrough pain can be difficult to manage, especially if you have late-stage cancer. However, you can treat it, just like you treat chronic pain.

See your doctor, who can adjust your pain reliever type or dose. They can also recommend other ways to help you deal with pain flare-ups.

Article resources
  • NCI dictionary of cancer terms: Breakthrough pain. (n.d.).
  • Caraceni A, et al. (2013). Guidelines for the management of breakthrough pain in patients with cancer. DOI:
  • Chronic pain: In depth. (2016).
  • Fact sheet: Breakthrough pain. (2016, February 21).
  • Fine P. (2010). The diagnosis and treatment of breakthrough pain.
  • Potter MB. (2006). Opioids for management of breakthrough pain in cancer patients.
  • Smith HS. (2012). Rapid onset opioids in palliative medicine. DOI:
  • Narayana A, et al. (2015). National breakthrough pain study: Prevalence, characteristics, and associations with health outcomes. DOI:
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