Search
breakthrough pain (BTP)
Intermittent exacerbations of pain that can occur spontaneously or in relation to specific activity.
Management:
1) common misconceptions:
a) maintenance opiates provide analgesia
b) opiate use for acute pain may result in addiction relapse
c) treatment breakthrough pain with opiates, in addition to maintenance opiates, may cause respiratory depression & CNS depression
2) general guidelines (opiates)
a) reassurance that pain will be treated adequately, verify & continue maintenance opiate
b) use non-opiate analgesics for breakthrough pain when feasible
c) use short-acting opiate when necessary, in addition to long-acting maintenance opiates
d) anticipate the need for higher scheduled doses due to tolerance.
e) prescribe scheduled rather than PRN doses
f) see opioid prescribing practices for dosing guidelines
Related
opioid prescribing practices
Specific
incident pain; movement-related pain
General
pain [odyn-]
References
- Alford DP, Compton P, Samet JH.
Acute pain management for patients receiving maintenance
methadone or buprenorphine therapy.
Ann Intern Med. 2006 Jan 17;144(2):127-34. Review.
PMID: 16418412
- NEJM Knowledge+ Pain Management and Opioids: Recharge
- Dowell D, Ragan KR, Jones CM et al
CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States,
2022.
PMID: 36327391 PMCID: PMC9639433 Free PMC article.