Breakthrough pain

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

Clinical picture
It is a very intense pain that starts suddenly. The differential diagnosis distinguishes it from pain that occurs after the end of the analgesic effect before the next planned dose (so-called end of dose pain ). At the same time, it is not an insufficiently alleviated 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 intending to prevent further episodes of breakthrough pain.

Rescue medications include, for example:


 * sublingual tablets with fentany;
 * fentanyl for intranasal use;
 * application of morphine (preferably IV or PO in the form of tablets or drops)

It is also used in combination with non-steroidal anti- inflammatory drugs, metamizole, or coanalgesics such as gabapentin and pregabalin.

When pharmacotherapy is exhausted, invasive procedures come next. Using catheter techniques, local anesthetics and opioids are applied to the epidural space or peripheral nerves in effective doses. For well-cooperative patients, so-called patient-controlled analgesia can be used, in 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 the inserted catheter.

Related articles

 * Analgetics

Reference

 * 1) ANTWERP, Frank. Durchbruchschmerzen  [online]. [feeling. 2020-12-01]. < https://flexikon.doccheck.com/de/Durchbruchschmerzen >.
 * 2) ↑ SLÁMA, Ondřej. BREAKTHROUGH PAIN - THE MOST COMMON CLINICAL FORMS, ASSESSMENT METHODS AND BASIC TREATMENT STRATEGIES  [online]. [feeling. 2020-12-01]. < https://www.linkos.cz/lekar-a-multidisciplinaryni-tym/kongresy/po-kongresu/databaze-tuzemskych-onkologickych-konferencnich-abstrakt/prulomova-bolest-nejcastejsi-klinicke-formy-zpusoby-hodnoceni-a -basic-strateg/ >.
 * 3) ↑ Czech Republic. COMPLETE Summary of product. 2019. p. 1. Also available from URL < https://www.sukl.cz/modules/medication/download.php?file=SPC147463.pdf&type=spc&as=lunaldin-spc >.