Breakthrough Pain: When the Usual Drugs Stop Working

Here is a scary real-life scenario: A chronic pain sufferer has her pain under control using a non-narcotic medication or a slow-release opioid, which has in the past worked for more than 12 hours. One day as she goes about things, a sharp spike of severe pain stops her in her tracks and she wonders what is going on.

Special drugs and approaches can control pain that "spikes" out of normal range. (HEALTH)

Special drugs and approaches can control pain that "spikes" out of normal range. (HEALTH)This is breakthrough pain, which is defined as a severe pain that spikes through controlled chronic pain, showing up like a horrible surprise guest and then departing.

A recent study in the Journal of Pain found that 74% of chronic noncancer pain patients reported experiencing severe-to-excruciating breakthrough pain.

Stopping Breakthrough Pain With Fast-Acting Drugs


How medication can keep chronic pain from spiking Read moreMore about pain medication

One such patient is Andrea Cooper, 52, of Phoenix, Md., who has fibromyalgia and spinal degeneration: "I'll take a pain med, which lasts between 12 and 24 hours. Well, after 10, let's say, I'll be walking down the street and get this searing pain that's building and building in my shoulder to the point that I feel my arm is going to blow off."

Cooper's breakthrough pain has been so severe at times that she's been forced to stop everything she's doing and lie down, even in places like a department store, until the wave of pain diminishes.

Breakthrough pain usually peaks quickly and lasts for a relatively short period of time—typically up to an hour.

Next Page: Who gets breakthrough pain? [ pagebreak ]Who gets breakthrough pain?

From cancer patients to nerve pain sufferers, anyone who takes medication to treat chronic pain can experience breakthrough pain.

"I was driving on the expressway, and just as I got off, my foot cramped up in so much pain I couldn't touch the brake," says Dorothy Teesdale, 70, of Lowell, Mich., who has suffered from peripheral neuropathy for 10 years. Teesdale managed to ease the car off the road and put it in park, but she was terrified by the experience. "To take medication and have this pain come and go—that was the biggest scare of my life," she says. Since then, she has had hand controls installed in her car.

"It's common to experience breakthrough pain if you have a condition that waxes and wanes," says Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University.

"For example, fibromyalgia sufferers can go for several weeks or months doing pretty well on a stable pain regimen, then for whatever reason their sleep gets messed up or something stressful happens and the pain shoots way up," says Dr. Chou.

Migraine sufferers get breakthrough pain too. "Let's say someone has six migraines a month and we put them on amitriptyline [an antidepressant drug used in low doses to treat pain], and then they have only three migraines and the pain is less severe, a bad attack can still break through," say Jan Lewis Brandes, MD, assistant clinical professor of neurology at Vanderbilt University School of Medicine, in Nashville, and a specialist in treating migraine. "None of the preventative drugs are perfect; despite the medication, some patients will still have breakthrough pain," she says.

To learn how medications can help manage breakthrough pain, check out "Stopping Breakthrough Pain With Fast-Acting Drugs."

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