Breakthrough Pain

Supplemental opioid (pronounced OH-pee-oyd) medication is used for breakthrough pain. The opioid is taken in addition to the medication prescribed for persistent pain.

Medication for breakthrough pain must be absorbed into your system rapidly to end intense short-term pain. It must then leave your system quickly to avoid heightening side effects such as lethargy.

For these reasons, the form in which you take breakthrough pain medication is important. Traditional oral agents, such as pills, take 15 to 30 minutes to reach peak levels. They also stay in the bloodstream for 3 to 4 hours. Medications administered rectally (suppositories) work more quickly, but can be less convenient and less desirable to use.

Research has shown that medication absorbed directly through the lining of the mouth (for example, rubbed along the inside of the cheek) is a good option for breakthrough pain relief.

The only pain medication given this way is called oral transmucosal fentanyl citrate (OTFC, or brand name: Actiq). Actiq is the only approved medication for treating breakthrough cancer pain.

Actiq is prescribed only if you're currently taking opioid medication for persistent pain. And it's important to remember that because it looks like a lollipop, this type of medication may attract young children, to whom it can be fatal. It must be kept in a locked area that is completely out of children's reach.

(Reminder: ALL opioids must be kept in a locked area, out of children's reach.)

If your breakthrough pain medication is taking too long to act, or is not giving you enough relief, discuss other options with your doctor. You may need to adjust your dosage, or you might do better with another drug. Depending on where you feel your breakthrough pain, other medications—such as antidepressants or local anesthetics—may give you added relief. The dose of oral short-acting opioids should be in proportion to your round-the-clock long-acting opioids.

Your pain may arise predictably when your regular dose of medication for persistent pain wears off. This is not considered breakthrough pain. Talk with your doctor about this pattern of pain. Your round-the-clock medication level may need adjustment.

Discuss with your doctor when to take medication for breakthrough pain. Ask specific questions related to your experiences with pain. Remember: There are no dumb questions!

In general, you'll add breakthrough medication as soon as you feel pain. If you know that an activity (for example, getting dressed) usually causes sudden pain, talk with your doctor about timing your dose to avoid that pain.

It's best to leave the doctor's office with two prescriptions: one for long-term medication for persistent pain, and another for short-term, breakthrough pain. These may be two different medications, containing different active ingredients.

Acute pain

If your pain is likely to improve on its own fairly soon (for example, pain right after breast or bone marrow biopsy), it's called acute pain.

To treat this, your doctor will select a short-acting medication that does not conflict with other medications you may be taking.