Breakthrough pain: Causes and medications
Breakthrough pain is also known as a flare-up or flare. It tends to occur in waves, peaking quickly then decreasing in intensity. It can last anywhere from minutes to hours.
Much of the research around breakthrough pain focuses on situations where it occurs in people with cancer. However, breakthrough pain has been linked to other conditions such as back pain, arthritis, shingles, fibromyalgia, diabetic neuropathy, and more.
Breakthrough pain often requires taking a different approach to pain relief. In this article, we look at the causes of this particular type of pain, along with the various ways of treating breakthrough pain.
Why does breakthrough pain happen?
Spikes of pain when taking pain medication are known as breakthrough pain.
Breakthrough pain can occur for a number of reasons. It may be triggered by the disease that causes the pain, the treatments or medications that people are taking to manage that disease, or other unrelated factors.
For some people, breakthrough pain can occur randomly and for no understandable reason. For others, there may be certain triggers.
Common triggers of breakthrough pain include:
- going to the bathroom
- any sudden movement
Any pain control is a balancing act between the amount of pain a person is experiencing and the amount of medication they take. This involves a person taking a regular amount of pain medication at a dose suitable for their level of pain, but not too much, or they may experience undesirable side effects, such as vomiting, a reduced ability to think, and tiredness.
There are also times where breakthrough pain occurs due to something that is known as end-of-dose failure. Any medication is subject to a peak time when a person experiences the drug's maximum effect, followed by a decreasing effect. This depends on many factors, including how the individual takes the medication.
For example, a pill takes 10-30 minutes to reach its maximum effect before it peaks and then wears off. Patches on the skin provide a more steady absorption, but their effect may still decline toward the end of the prescribed time.
End-of-dose failure is when the level of pain relief provided is not enough in the last few hours before the next dose is due.
Stats on breakthrough pain
Estimates vary, but medical research indicates that breakthrough pain occurs in:
- about 70 percent of people with chronic noncancer pain
- up to 65 percent of people with chronic cancer pain
One study of people with cancer who were receiving end-of-life care reported that 80 percent experienced cancer pain. Of this group, 80 percent reported experiencing breakthrough pain.
Drugs for breakthrough pain
Some medications may help to manage breakthrough pain.
Simply increasing the dosage of current pain medication is not thought to be an effective way to manage breakthrough pain. This is because an increase of the pain medication can lead to an overdose and cause unwanted or even dangerous side effects.
There are some medications that doctors do prescribe to help manage the discomfort of breakthrough pain.
However, these drugs must:
- take effect quickly
- be short-acting, to get people through the flare-up and then wear off shortly afterward
- be quick and easy to take
The drugs designed for breakthrough pain come in different forms, such as:
- nasal sprays
- rapidly dissolving film placed on the inside of a person's cheek
- over-the-counter pain relievers, such as ibuprofen or naproxen sodium
These over-the-counter medications are often referred to as nonsteroidal anti-inflammatory drugs (NSAIDs).
Their use in breakthrough pain is to help provide extra pain relief, working alongside prescription pain drugs. They also help to spread out the times at which people take their medication and reduce the amount of prescription pain medication needed.
Risks and side effects of treatment
Medications to manage pain come with a range of different side effects:
NSAIDs, such as ibuprofen and naproxen sodium, can cause the following side effects:
Taking medication with food can help relieve some of these side effects.
Long-term use of over-the-counter or prescription pain medications can also cause the following health problems:
Other side effects and risks include:
- rash or another allergic reaction
- swelling of the hands and feet
- greater risk of infection
- increased appetite
- loss of appetite
Different pain medications come with different risks and side effects. Many people do not experience any adverse effects at all, however.
It is important for people to check with their doctor if they are unsure or concerned about the side effects of any medications they take.
Anyone who experiences any side effects that they are worried about must contact their doctor immediately.
Alternative methods of treatment
Acupuncture may be recommended as an alternative treatment.
There are alternative forms of treatment available for people who do not find pain medication useful for relieving breakthrough pain.
Many people who experience chronic pain choose to try out different forms of relief. These options include:
Acupuncture: Needles are used to stimulate certain points on the body. Practitioners believe that acupuncture can release pain-numbing chemicals or block pain signals to relieve pain.
Marijuana: Medical marijuana is sometimes prescribed to help with certain types of pain relief.
Therapy: Some people find therapy helps with managing their pain. Options include music therapy, relaxation therapy, meditation, and hypnosis.
Massage: Massage can help ease tension and pain, particularly in people with arthritis or neck and back injuries.
Gentle exercise: Physical activity has been proven to relieve pain and release feel-good endorphins that help to boost energy levels and mood.
People are advised to consult their doctor before trying these pain-relieving methods.
Many people find that they can control breakthrough pain with proper medication and management.
When taken alongside long-term medication, a fast-acting pain reliever used as and when needed may help alleviate breakthrough pain associated with an illness or injury.
If breakthrough pain goes untreated, these sudden flare-ups can cause significant damage and disruption to a person's day-to-day life. The pain may make it difficult for them to enjoy everyday activities, which can negatively affect their overall sense of well-being and happiness too.