Treatment of Breakthrough Pain
Breakthrough pain is a common problem for many patients, so additional opioid doses should be prescribed on an as-needed basis. These additional opioid doses should be approximately one half of the regular four-hour opioid dose, or about 10% of the 24-hour dose. For patients on opioid infusions, the breakthrough dose is usually 50% to 100% of the hourly infusion rate. Regular use of additional doses (more than three to four times daily) may signal the need to increase the baseline dose or the need for an adjuvant analgesic.
The information below describes three types of breakthrough pain and strategies for treatment.
Type: Incident
Characteristics:
Activity-related
Has identifiable precipitant
Usually nociceptive
Solution:
Anticipate and pre-medicate with short-acting agent
Type: Idiopathic or Spontaneous
Characteristics:
Unpredictable
Usually neuropathic visceral
Solution:
Add adjuvant medication
Type: End-of-dose Failure
Characteristics:
Predictable return of pain before next scheduled dose of medication
Solution:
Increase dose or shorten the time between dose of the long-acting agent (e.g., every eight hours instead of every 12 hours)