Approach to managing breakthrough pain in palliative care

Breakthrough pain is a spontaneous exacerbation of pain. Its duration varies widely. Breakthrough pain may be due to:

• an occasional natural fluctuation in pain
• inadequate regular opioid therapy
• inadequate pain management.

For patients with palliative care needs who experience breakthrough pain, consider and address factors that could be contributing to the pain—see Key questions to assess poor response to pain management in palliative care for key questions to assess poor response to pain management.

Breakthrough pain is commonly treated with an immediate-release opioid. The dose depends on whether the patient already takes regular opioid therapy:

• for patients not taking regular opioid therapy, see As-required oral opioids for intermittent pain in patients with palliative care needs who do not already take a regular opioid
• for patients who already take a regular opioid, see Immediate-release opioid therapy for breakthrough pain in patients who take a regular opioid.

Whenever breakthrough doses are taken, the regular dose of opioid should still be taken at the scheduled time.

In contrast to breakthrough pain, incident pain occurs with, or is exacerbated by, a specific event (eg movement, changing a wound dressing), and is managed differently—see Incident pain in palliative care.

For management of acute pain, including severe acute pain (which is a medical emergency), see Acute pain in palliative care.