Breakthrough pain

Breakthrough cancer pain (BTCP) is an escalation of pain in a patient with chronic stabilized pain. The term is used mainly in patients with cancer. It occurs in 40-70% of them. The etiology is combined, but breakthrough pain often occurs in acute exacerbation of the underlying disease.

Clinical picture
This is a very intense pain that starts suddenly. In differential diagnosis, it differs from the pain that occurs after the analgesic has stopped before the next scheduled dose (so-called end of dose pain). At the same time, it is not an insufficiently mild pain that the patient feels most of the day.

Therapy
Treatment consists of so-called rescue medication (rescue drugs) that quickly relieve pain and subsequent adjustment of the treatment plan with the aim of preventing further episodes of breakthrough pain.

Rescue medications include, for example: It is also used in combination with non-steroidal anti-inflammatory drugs, metamizole, or analgesics such as gabapentin and pregabalin.
 * fentanyl sublingual tablets ;
 * fentanyl for intranasal use;
 * application of morphine (preferably i.v. or p. o. in the form of tablets or drops).

When pharmacotherapy is exhausted, invasive procedures come into play. With the help of catheter techniques, local anesthetics and opioids are applied to the epidural space or peripheral nerves in effective doses. In well-cooperating patients, so-called patient-controlled analgesia can be used, during which the patient can increase the dose as needed (the upper limit of boluses is set). The disadvantages of invasive procedures are the need for interdisciplinary cooperation with an anesthesiologist, in most cases hospitalization and complications associated with an indwelling catheter.

Related articles

 * Analgesics