Breakthrough pain:
(1) This is a transitory increase in pain.
(2) The pain is moderate to severe in intensity.
(3) The patient is receiving analgesia that normally provides a reasonable degree of pain relief.
(4) It may arise from somatic, visceral, and/or neuropathic causes.
Exclude:
(1) inadequate baseline pain medication
(2) end of dosing interval for pain medication
(3) opioid abuser attempting to obtain more pain medication
In order to develop an appropriate management strategy, it is important to determine:
(1) if the pain is predictable (associated with a particular movement or activity) or not
(2) the frequency of the breakthrough episodes
Possible management strategies:
(1) increase baseline pain medication (especially if the patient has multiple episodes every day)
(2) increase pain medication prior to triggering events
(3) provide rescue medication, ideally a rapid-acting analgesic
(4) avoid precipitating factors if possible
(5) in the acute setting, consider patient-controlled analgesia (PCA)
