(1)
Department of Anaesthesia, Royal Free Hospital, London, UK
Cancer patients experience episodes of increase in pain on a background of continuous pain. Breakthrough pain is defined as a transitory exacerbation of pain that occurs on a background of otherwise stable pain in a patient receiving chronic opioid therapy (Portenoy and Hagen 1990).
It can be further classified into:
Spontaneous pain (26 %): occurs without any provoking factor
Incident pain (42 %): seen due to either voluntary act (movement) or involuntary act (cough, sneeze)
The pain may also be seen because of decreasing levels of analgesia. The prevalence of breakthrough pain is between 20 and 80 %.
41.1 Diagnostic Criteria (Portenoy and Hagen 1990)
Presence of stable analgesia in the previous 48 h
Presence of controlled background pain in the previous 48 h
Presence of temporary flares of severe or excruciating pain in the previous 24 h
It is seen more in those with advanced stage pain because of spinal involvement or nerve plexus involvement. It may be seen because of the disease itself, because of the treatment for the disease or because of the associated comorbidities.
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