Peer Reviewed
Pain management

Breakthrough pain in patients with chronic noncancer pain

Roger Goucke
Management of breakthrough pain on a background of chronic noncancer pain – in such patients the term incident pain is preferred – is aimed at improving function and decreasing pain and distress rather than complete relief of pain.
Key Points

    From time to time, patients with persistent or chronic pain present with either increased pain or some variant of breakthrough pain. The term ‘breakthrough pain’ is derived from cancer pain management and has been defined as a transient worsening of pain breaking through an existing effective analgesic regimen. Because complete analgesia is not always possible for patients with chronic noncancer pain, this term is not widely used in this population.

    Instead, the term ‘incident pain’ is used to describe pain similar to breakthrough pain that occurs as a frequent predictable pain exacerbation brought on by certain activities. This pain may occur on a background of continuous pain, or the patient may be completely pain-free between episodes. Pain on movement or coughing after abdominal surgery is a good example of ‘incident pain’.

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