Breakthrough pain (BTP) is just that, a sudden onset level of pain that is separate from the ongoing pain generally well managed by medication, particularly in cancer patients. Breakthrough pain is a short-term flare up of increasing intensity that occurs either spontaneously or as a response to a specific trigger. Effective management and treatment of breakthrough pain is dependent on the accurate diagnosis and assessment of the reported pain.1
Prostate cancer and pain management
Various reports state that up to 75% of those with advanced cancer experience pain. Pain can be generally be managed using medications and non-pharmacological treatments. With good reporting of pain, management can be planned. Available treatments make it possible to relieve pain for most, but cancer pain remains inadequately treated in over 50% of patients.
Side effects from prostate cancer can include sexual dysfunction, difficulty urinating, and pain. In a recent Health Union survey of nearly 1,000 patients and caregivers, pain was reported in 20% of respondents.3 Pain can occur in the same area on a repeated basis, and it can also be referred pain, where injury to one part of your body is felt as pain in another area. Good pain management is dependent on accurate and timely reporting to your medical team. Descriptions of how you are experiencing pain, when and where, how long it lasts, and relation to the medication cycle can help you get the best care possible. Consider keeping a pain diary to record this information.
What is breakthrough pain?
BTP comes on quickly, is of high intensity, and short duration. It occurs at the same time as continuous pain but feels different. It is generally experienced by 40–60% of patients treated for pain.2 End of dose failure that occurs as the medication cycle wears off, is not technically breakthrough pain.
Breakthrough pain can include:
Incidental pain triggered by a specific, predictable action or movement
Spontaneous or idiopathic pain that is unpredictable and not triggered by a specific activity
Many patients say they have never been educated about cancer pain, particularly breakthrough pain. The medical profession needs to do a better job of making people aware that BTP may occur. With the understanding that they may develop pain, patients need to be able to report the symptoms and work with their medical team to manage discomfort.
Managing breakthrough pain
For ongoing pain maintenance, physicians generally prescribe long acting opioid medications. Short acting medications should be simultaneously prescribed for treating breakthrough pain as a rescue medication. Pain medications are generally orally taken. A combination of long and short acting drugs can provide better pain relief and fewer side effects.2 Note that 92% of the treatments prescribed are highly addictive narcotics.3 Pain control must be closely managed by the medical team to balance effective relief with otherwise adverse side effects and risk of addiction.
Some people manage their pain with medications and others are able to use non-pharmacological methods.
About half of all BTP is neuropathic nerve pain. This kind of pain is not treated with short acting rescue drugs; it is generally managed by increasing doses of maintenance medications. Pain clinics are experienced in treating cancer patients. Finding the right combinations of medications can be challenging and for some, it is necessary to see an expert to find the right combinations of medications to alleviate or eliminate BTP flare-ups.
What should I expect with BTP?
Some men with advanced prostate cancer will experience pain, especially if the cancer has spread to their bones.4 Pain can be caused by the cancer, cancer treatments, or infections. BTP can affect your quality of life by limiting physical activity and contributing to psychological conditions like anxiety, depression, and isolation. The side effects of BTP can impact the person being treated as well as their caregivers. It can increase stress at home and create a financial burden for patients and their families.
The literature reports that BTP can vary in frequency, intensity, onset, duration, and predictability.1 Successful pain management can usually be achieved when assessments evaluate patterns of background and breakthrough pain.1 With personalized treatment regimens, pain can generally be relieved or reduced. Education around pain experiences should improve communications with the medical team, and result in increased patient reporting and improved access to BTP management. That, in turn, should improve the lives of people with advanced prostate cancer.
Davis, M.P. Breakthrough Pain in Cancer Patients— Characteristics, Impact, and Assessment. US Oncology & Hematology, 2011;7(1):12-6 . Published July 2011. http://www.touchoncology.com/articles/breakthrough-pain-cancer-patients-characteristics-impact-and-assessment. Accessed online August 18, 2018.
Rudowska J. Management of breakthrough pain due to cancer. Contemp Oncol (Pozn). 2012;16(6):498-501. Published January 4, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687475/. Accessed online August 15, 2018.
Prostate Cancer Survey Highlights Impact on Social, Emotional Well-Being. Published April 2018. https://health-union.com/news/prostate-cancer-survey-emotional-impact/. Accessed online August 18, 2018.
Managing pain in advanced prostate cancer. Prostate Cancer UK website. Updated May 2017. https://prostatecanceruk.org/prostate-information/advanced-prostate-cancer/managing-pain-in-advanced-prostate-cancer. Accessed online August 17, 2018.