Management of Breakthrough Pain in Cancer Patients - Episode 3

Assessing and Treating Breakthrough Cancer Pain

According to panelist Jeri L. Ashley, RN, MSN, AOCNS, CHPN, the optimal management strategy for breakthrough cancer pain "varies from patient to patient and condition to condition." In some cases, pain may progressively get worse until it is adequately controlled, while in other situations, pain may occur so fast that a patient doesn't even have time to react, Ashley states.

There are various categories of pain medications available to address each unique type of pain, such as long-acting, short-acting, or rapid-onset opioids. In general, Marc Rappaport, DO, recommends starting with short-acting medications and then moving to long-acting formulations.

For patients who experience severe bursts of pain, Rappaport utilizes rapid-onset opioids. These treatments improve quality of life, and, in some scenarios, can replace intermediate-dose narcotics.

The availability of rapid-onset medications synchronizes with patient requirements, Charles E. Argoff, MD notes. In most situations, patients are asking for a pain medication that works rapidly.

Occasionally, a patient with established chronic pain develops cancer, Vitaly Gordin, MD, explains. These patients are most likely already taking opioids, thus requiring a more comprehensive evaluation. Additionally, before administering treatment, a comprehensive assessment should be conducted to ensure patients are not using other medications, such as benzodiazepines, antidepressants, anticonvulsants, Gordin suggests.

For patients with cancer who are experiencing pain, the National Comprehensive Cancer Network (NCCN) guidelines provide general advice on optimal management techniques, Rappaport notes. However, most physicians are still utilizing their own approaches to pain management. As a result, the incorporation of rapid-onset opioids into these guidelines represents a first-step in the education process for many physicians, Rappaport believes.