Understanding Breakthrough Pain

Millions of Americans live with constant pain. The good news is that pain medication usually does a good job controlling it. But what if pain suddenly gets worse, your pain medication wears off too soon or you do something that aggravates your pain condition? That's called breakthrough pain.

According to the American Pain Society, millions of Americans live with arthritis, cancer pain, back pain, migraines, fibromyalgia and other chronic pain conditions.  The American Pain Foundation says there are two types of chronic pain:  background pain and breakthrough pain.

  • Background pain is the constant, chronic pain associated with your condition.
  • Breakthrough pain is additional, sudden and often unpredictable.

What Causes Breakthrough Pain? 

Doctor's don't always know what triggers breakthrough pain but sometimes its directly connected to something we've done or can pinpoint. For example, If you have arthritis that's usually well controlled but you do an extra-challenging workout, you might experience breakthrough pain. Similarly, if you have cancer pain or surgical pain and your long-acting medication isn't enough to compete with your activity level, you may experience breakthrough pain. 

Sometimes, breakthrough pain is a sign you're developing a tolerance to your narcotic pain medication. Sometimes, sadly, it means your disease is progressing. Whatever the cause, pain management is available to make you more comfortable.

Chronic pain is best managed with long-term or extended relief medication and fast acting, short term, "rescue" medication that rescue the patient from sudden attacks.  Long-term medications include: nonsteroidal anti-inflammatory medications and narcotics like Oxycontin, Fentanyl, morphine and Dilaudid.  Short-term medications include over-the-counter analgesics like Tylenol and stronger prescription medications like Vicodin and Percocet. 

Sometimes the best solution is to switch from one medication to another. For example, if your pain has been adequately managed with Vicodin but you're experiencing more episodes of breakthrough pain, talk to your doctor about other narcotic medications. 

Another classification of medications that might be effective for treating breakthrough pain are called NMDA antagonists.  They're thought to block neuro-receptors that may be overactive in pain conditions like fibromyalgia.  They're also effective for patients who've built up tolerance to narcotic medications.  Many patients find relief with certain types of antidepressants or medications that help them achieve higher-quality sleep.  

Sometimes the best medicine is not a prescription, but addressing lifestyle issues that may increase your pain.  Sleep, stress reduction, safe exercise and a healthy diet go a long way towards supporting your body's ability to live comfortably.  If you're experiencing regular bouts of breakthrough pain, talk to your doctor and ask for a referral to a pain clinic or specialist.


American Pain Foundation: http://www.painfoundation.org/learn/

American Pain Society: http://www.painfoundation.org/learn/