Pain Management Q&A by Dr. Helm
I suffer from chronic back pain and take pain medication frequently. I often suffer severe pain episodes, or spikes in pain. I was told this is "breakthrough pain." What is breakthrough pain? And is there treatment for it?
For people who suffer pain all of the time, the concept of breakthrough pain addresses the fact that the level of pain experienced can vary throughout the day. The pain can vary because of different activity levels, medication wearing off, or just "because it does." If a patient were given enough medication to treat all of these spikes in pain, they run the risk of having side effects from being over-medicated. Because pain medications are provided to help improve overall patient function, these side effects are undesirable and should be avoided. The goal is to provide enough sustained release medication to meet the patient's baseline needs, and then add supplemental short acting medication to take when the pain spikes occur.
The only study on breakthrough pain was done in cancer patients. It found that up to about three spikes in breakthrough pain occur during the day. In general, the limit on prescription of medications for breakthrough pain is about three or four doses per day.
Thank you for your question.
Last Editorial Review: 11/28/2006