Management of Breakthrough Pain in Cancer Patients - Episode 2

Numeric Rating Scales for Breakthrough Cancer Pain

Numeric rating scales can be utilized to assess the severity of breakthrough pain for patients with cancer, according to panel moderator Jeffrey A. Gudin, MD. However, in addition to numerical tools, clinicians should consider daily activities and medical history, such as whether the patient is at the end of the dose or has undertaken new activities, according to Charles E. Argoff, MD. Adding these questions to the assessment will provide an accurate measure of the events leading to the breakthrough pain.

If a patient is reaching the end of a dose, the long-acting analgesic may be wearing off and causing breakthrough pain, Gudin adds. Moreover, if there is a correlation between breakthrough pain and a strenuous activity like exercise, then proper preventive measures like fast-acting pain medications can be used to avoid the event, Argoff states.

This assessment is particularly relevant in patients with cancer, since breakthrough pain could be a direct result of the treatment they are receiving, Marc Rappaport, DO, notes. As a result of the variation in the cause of breakthrough pain, the treatment approach should also be different for patients with cancer, he adds.