Management of Breakthrough Pain in Cancer Patients - Episode 3

Assessing and Treating Breakthrough Cancer Pain

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The optimal management strategy for breakthrough cancer pain varies from patient-to-patient, suggests Jeri L. Ashley, RN. In some cases, pain may progressively get worse, until it is adequately controlled. In other situations, pain may occur so fast that a patient doesn't even have time to react, Ashley states.

There are various categories of pain medications available to address each unique type of pain, such as long-acting, short-acting, or rapid-onset opioids. In general, Marc Rappaport, DO, recommends starting with short-acting medications, then moving to long acting formulations.

For patients who experience severe bursts of pain, Rappaport utilizes rapid-onset opioids. These treatments improve quality of life, and, in some scenarios, could replace intermediate dose narcotics. The availability of rapid-onset medications synchronizes with patient requirements, notes Charles E. Argoff, MD. In most situations, patients are asking for a pain medication that works rapidly.

Occasionally, a patient with established chronic pain develops cancer, notes Vitaly Gordin, MD. These patients are most likely already taking opioids, requiring a more comprehensive evaluation. Additionally, before administering treatment, a comprehensive assessment should be conducted to ensure patients are not using CPAPs or other medications, such as benzodiazepines, antidepressants, anticonvulsants, Gordin suggests.

For patients with cancer experiencing pain, the NCCN guidelines provide general advice on optimal management techniques, notes Rappaport. However, most physicians are still utilizing their own approaches to pain management. The incorporation of rapid-onset opioids into these guidelines represents a first-step in the education process for many physicians, Rappaport believes.