Management of Breakthrough Pain in Cancer Patients - Episode 11
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Pain commonly occurs for patients with cancer as a direct result of the tumor or treatment, explains Fadi S. Braiteh, MD, from Comprehensive Cancer Centers of Nevada. In general, patients with cancer experience 3 types of pain: visceral, somatic, and neuropathic. In Northern America, diabetic neuropathy is common, prior to treatment for cancer, notes Braiteh. In many situations, platinum-based agents and taxanes can exacerbate this pain. Unfortunately, neuropathic pain can be cumulative, making it harder to treat, Braiteh notes.
In addition to the chemical and physical causes of pain, there are also psychological interpretations of pain, which vary from patient to patient. As a result of this psychological aspect, if pain becomes more severe it often worsens other side effects, such as insomnia, anorexia, shortness of breath, vomiting, diarrhea, lack of sleep, and fatigue, Braiteh notes.
In general, pain can be controlled for patients with cancer using various medications, such as long-acting narcotics. These treatments are usually broken into several doses that can be given throughout the day, Braiteh says. Additionally, transdermal fentanyl patches can be utilized to help control pain. For patients who experience sudden pain spikes, labeled breakthrough cancer pain, in addition to their baseline pain, other treatments may need to be utilized.
In general, breakthrough pain occurs quickly and last for 30 minutes. These flares can occur several times a day; however, if breakthrough pain is occurring frequently, it could be indicative of suboptimal baseline pain management, Braiteh cautions. In order to treat it adequately, breakthrough pain should to be distinguished from other types of pain, such as the pain experienced when a long-acting medication begins to wear off toward the end of a dose, Braiteh notes.
Incidental breakthrough pain occurs as a result of a certain procedure or activity, Braiteh notes. This type of pain is often predictable and can be countered prior to it occurring. Identifying this type of breakthrough pain is important, since it can be anticipated and prevented, Braiteh states.