Management of breakthrough pain due to cancer

Breakthrough pain is defined as the transient exacerbation of pain occurring in a patient with otherwise stable, persistent pain. Breakthrough pain is relatively common among cancer patients, particularly those with moderate to severe background pain, and is one of the most difficult pain syndromes to treat. Breakthrough pain may be caused by patient movement (incident pain) or may be unrelated to patient action (spontaneous pain). Although breakthrough pain is usually managed pharmacologically with supplemental opioid medication, other means of treatment should also be considered. Primary antineoplastic therapies may alleviate the cause of some breakthrough pain, and other types of primary interventions may at least lessen this type of pain. Before a change in the around-the-clock analgesic dosage is implemented, the clinician should consider analgesic side effects, the number of episodes of breakthrough pain per day, and the best means for balancing side effects vs analgesia. The addition of pharmacologic agents to treat analgesic side effects may improve the overall side effect profile. Because breakthrough pain involves moderate to severe pain of rapid onset, use of a fast-acting, effective analgesic can be crucial to successful treatment.