What Is Breakthrough Pain?

  • Medical Author:
    Standiford Helm II, MD

    Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Ask the experts

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?

Doctor's response

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.

Medically reviewed by Wayne S. Blocker, MD; Board Certification in Obstetrics and Gynecology


"Use of opioids in the management of chronic non-cancer pain"

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Reviewed on 8/31/2017