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Thursday, May 15, 2008  Home : Breakthrough Pain : Breakthrough Pain Facts Tolerance is defined as a need for a larger dose of medication to maintain the original effect. Temporal features, including the onset, duration and frequency of each episode, characterize breakthrough pain. As patients learn that certain actions cause breakthrough pain, these episodes can be anticipated and may allow patients and physicians to either prepare a treatment response or to treat prophylactically. Baseline pain is also known as "background pain", or "persistent pain". Specific characteristics that define breakthrough include its relationship to the fixed opioid dose for persistent pain, temporal features, precipitating events, and predictability. Episodes of breakthrough pain may either be spontaneous, occurring without a precipitated event, or precipitated; initiated by a volitional or nonvolitional event. The etiology of breakthrough pain can be related to a disease or condition, or to its treatment. Although specific etiology may not explain manifestation as breakthrough pain, determination is essential for effective management. Breakthrough pain is associated with greater pain-related functional impairment, worse mood, and more anxiety. Episodic pain is also known as Breakthrough Pain. Chronic pain can be or two types: persistent pain, which is continuous pain, and breakthrough pain, or incident pain. Breakthrough pain is called that because it "breaks through" a regular pain medicine schedule. Breakthrough pain may be different for each person and it is often unpredictable. Breakthrough pain typically has a rapid onset, can last up to an hour. The quality of breakthrough pain may feel very much like persistent pain, except that it is more severe. Breakthrough pain is generally a result of the same cause, or source, as persistent pain. Medications used for treating breakthrough pain, as generally short-acting medications, and are called rescue medicines. Rescue medications, which are short acting, are used to manage and resolve breakthrough pain episodes more rapidly. Rescue medications stay in your system for a shorter duration of time. Breakthrough pain is relieved with rescue medications, or short-acting medications, that are taken ONLY at the time of a breakthrough pain episode. Breakthrough pain medications work directly to control severe flare-ups. Breakthrough pain is more common in the cancer patient population. Pain can occur even through a patient is adhering to their medication schedule and are taking the correct dose of pain medication. Side effects experienced when taking rescue medications are generally the same as those experienced when taking long-acting medications for persistent pain. Rescue medication should be taken at the first sign of breakthrough pain. Pain that is allowed to build up is much harder to control. It is possible to experience breakthrough pain just before or just after taking your persistent pain medication. If you regularly experience breakthrough pain just before taking your regularly scheduled pain, you should speak with your physician or nurse, as your medication or dosage may need to be adjusted. You should always check with either your doctor, nurse or pharmacist, to make sure that your pain medications can be taken safely with any of the other medications that you might be on. It is wise to use only one pharmacy, that way the pharmacist can track the medication and be alerted to any possible adverse interactions between medications. If your breakthrough pain medication does note relieve your pain, or if your pain requires you to take your rescue medication more than four times a day, you should contact your physician or nurse. In 1990, Doctors Portenoy and Hagen, proposed that "transient" increases in pain, in the cancer patient who has been responding to opioid treatment and has stable, persistent pain be termed "breakthrough pain". A survey by the Task Force on Cancer Pain on the International Association of the Study of Pain (IASP) noted that breakthrough pain is recognized, referred to, and defined differently in different countries. In the United Kingdom, clinicians use the term "breakthrough pain" to refer to pain that is precipitated by patient movement or activity. The World Health Organization (WHO) issued guidelines for matching the potency of analgesics with the intensity of pain. The three-step approach was recommend in 1990 and revisited in 1996. The WHO guidelines do not specifically address breakthrough pain. In 1994, the Agency for Healthcare Research and Quality (AHCPR) defined breakthrough pain as "intermittent exacerbations of pain that can occur spontaneously or in relation to specific activity". The Agency for Healthcare Research and Quality (AHCPR) guidelines do not contain specific recommendations for assessing breakthrough pain and/or selecting and analgesic or analgesic does of medication to treat breakthrough pain. An increase in pain may occur prior to the next regularly schedule pain medication dose, because the medication concentration there may be a plasma concentration decline. Movement-related pain is often referred to as "incident" pain. Incident pain, or movement-related pain, can occur as a result of coughing, swallowing, positional changes, and activity. Breakthrough pain could be related to: a direct relationship between a tumor progression, such as bone metastasis, or nerve compression, in the cancer patient, or as a result of a treatment modality, such as a prostatectomy or mastectomy, or a variety of disorders, such a arthritis. Currently, there is not an independently validated assessment tool available to evaluated breakthrough pain. When reporting breakthrough pain episodes to your physician or nurse it is important to note the frequency, onset and duration and any precipitating factors that are related to the number of episodes your are experiencing. Treating breakthrough pain with oral medication is the most convenient and cost-effective for patients. When treating breakthrough pain, oral medications can take up to 30 or 45 minutes to reach effectiveness. When treating breakthrough pain, rectal medications, such as liquid morphine can produce effective analgesia in approximately 10 minutes. Recent studies have shown that breakthrough pain can independently contribute to impaired functioning and psychological distress. Researchers estimate that up to 86% of chronic pain suffers, on long-acting medication, experience breakthrough pain. The term "end-of-dose failure" is used to describe the type of breakthrough pain that is intense or severe just prior to the time when you should have be taking your next dose of regularly scheduled pain medication. Breakthrough pain medication can be given in the following forms: orally, rectally, sublingually, transmucosally, intravenously, or my injection. Keeping a "pain diary" can help you communicate with your doctor about your pain control needs. Non-pharmacological techniques for breakthrough pain consist of relaxation training, imagery, hypnosis, distraction, touch, and music and pet therapy. Breakthrough Pain generally falls within three classifications: incident, end-of-dose failure, and spontaneous.