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Breakthrough Pain

The Oxford American Pain Library provides practical guides that cover current approaches and new developments in the assessment and management of pain. The Diagnosis and Treatment of Breakthrough Pain is meant for doctors and nurses but can also provide some insight into treatment options for patients suffering from uncontrolled pain flares. In the excerpt below we learn what breakthrough pain really is.

The term “breakthrough pain” began appearing in the medical literature in the 1980s on the heels of the increased attention, brought about by the World Health Organization, to the global problem of undertreated cancer pain. During that time, it became apparent that cancer patients commonly experience intermittent exacerbations of severe pain against a background of continuous, or baseline, pain. Episodic pains that would “break through” during the treatment of background pain that was otherwise well controlled through the use of around-the-clock opioid therapy were catergorized by Portenoy and Hagen (1990) in a seminal work titled “Breakthrough pain: Definition, prevalence and characteristics.” The definition of breakthrough pain proffered in that article took root and has been used in pain management parlance ever since.

As opioid therapy has become more commonly used in the treatment of chronic noncancer pain over the last decade, it have become equally apparent that similar patern of supervening severe pain episodes can confound otherwise well-managed chronic pain (Seppetella et al., 2001). Recognizing the similarities of sympotms, independent of underlying pathophysiology, a group of pain managment experts came together in 2006 to create a unifying definition, based on a review of all the literature on the subject in all populations studied to date. The more generalized definition incorporates the additional observation that breathrough pain seriously disrupts the quality of patients lives. Therefore, the term breakthrough pain is now categorically determined to define the particular clinical circumstance wherein patients who have controlled baseline pain experience severe episodes of pain that breaks through the medical therapy (usually opioids) that has relieved the baseline pain.

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