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What is Breakthrough Pain? Symptoms and Treatment

Breakthrough pain is a recent concept that refers to a condition that occurs specifically in people with cancer. It’s a brief pain that appears suddenly in people who already have a painful condition.

In other words, breakthrough pain appears in people who already have a pain base and who, generally, are already on medication to alleviate it. However, this breakthrough pain is so intense that it exceeds the effectiveness of this treatment and is unbearable for those who suffer it.

It affects many people with chronic processes. Specialists estimate that 2 out of every 3 patients who experience cancer pain also suffer breakthrough pain. In addition, it’s absolutely unpredictable.

It’s a very intense experience that interferes in the quality of life and well-being of these people that are already suffering from a painful condition. Therefore, in this article we want to explain everything you need to know about it.

What is breakthrough pain?

Actually, the definition of breakthrough pain, according to the Spanish Society of Medical Oncology, is a little more specific. It defines it as a transitory, sudden and very intense exacerbation that appears on a persistent pain base.

Therefore, this pain appears in people who are already being medicated to control the pain they’re suffering from. In addition, breakthrough pain can be classified into different types:

  • Incidental, which in turn can be predictable or unpredictable. Incidental breakthrough pain is pain that’s related to muscle movement, such as coughing or sneezing.
  • Idiopathic, which cannot be related to any specific cause.
  • Breakthrough pain that appears as a result of a decrease in analgesics. It usually appears when the dose of the analgesic that controls the pain has been taken for a long time. It’s also common when the period between one analgesic and the next is too long.

What are the symptoms?

How breakthrough pain manifests vary from patient to patient and depends mainly on the underlying pain. For example, it may be a sudden and severe increase in leg pain, in the case of a knee sarcoma.

As with any other pain, it’s normal for the person to appear sweaty, with accelerated breathing and tachycardia. The skin usually becomes paler and all the muscles tense.

Breakthrough pain treatment

In order to establish a complete treatment, we first have to understand that it’s not merely physical. Breakthrough pain is a situation that complicates the patient’s life and also has psychological repercussions.

Therefore, treatment should be both pharmacological and non-pharmacological. People who suffer from it often need psychological support, relaxation methods, and techniques to deal with the pain.

Ideally, the doctor should try to treat the agent that’s causing this pain, or at least try to prevent pain peaks. In addition, medical treatment should follow a series of therapeutic strategies depending on the type and intensity of the pain.

The most commonly used drugs are opioids; two common ones are fentanyl and morphine. The problem is that, when the pain is already present, it’s very difficult to palliate it with common analgesics. The same happens with opioids taken orally.

For this reason, substances of ‘transmucosal absorption’ are usually used. This causes the drug to pass through the mucous membranes and reach the bloodstream directly. Thus, relief is much faster and more effective. An example is the area under the tongue.

In conclusion

A person with a painful oncological process or a chronic disease can suffer peaks of exacerbation of that pain which is known as breakthrough pain.

It’s essential that we understand the complexity of this situation in order to be able to help those who suffer from it both physically and mentally. Nevertheless, the doctor should be the one to determine the best treatment for each case.

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