What is meant by breakthrough pain?
If a patient has acceptable baseline pain control on a stable analgesic regimen and suddenly develops an acute exacerbation of pain, this is referred to as breakthrough pain. It often occurs toward the end of a dosing interval, because of a drop in analgesic levels (end-of-dose breakthrough pain). “Incident” pain is a type of breakthrough pain that occurs either with a maneuver that would normally exacerbate pain (weight bearing on an extremity with a bone metastasis) or with sudden disease exacerbation (hemorrhage, fracture, or expansion of a hollow viscus). Breakthrough pain can occur in an idiopathic fashion as well. The concept of breakthrough is generally accepted for cancer-related pain but is more controversial for non-cancer-related pain.
Recognizing the type(s) of breakthrough pain is important for treatment purposes. Pain consequent to decreasing analgesic levels may be controlled by increasing the dose or shortening the intervals between doses (if not otherwise contraindicated). Incident pain may be addressed by administering a dose of an appropriate analgesic before the exacerbating activity.
