Breakthrough Pain

My daughter was happy when I told her I was starting a blog. But she was less excited about my chosen topic. She wrinkled her eyes and said “Mom” in that certain tone they use to express a sort of morbid disapproval.

“I won’t make it a sad thing,” I promised. “I’ll make it positive and informative and hopeful.”

“Right,” she said. “It’ll still be a bummer.”

I know that in a way, she was right. Pain is something everyone can empathize with, but only up to a point. Some areas of pain treatment and management are just not that easy to discuss. One of them is breakthrough pain.

Breakthrough pain, which can be as sudden and as searing as a bullet, lasts anywhere from an instant to an hour. However long it lasts, dealing with that level of pain is personal and dark and difficult.

Although it’s most common in cancer pain patients, I’ve had my run-ins with breakthrough pain (BTP). The most memorable came on the night my family and I got home from a vacation two years ago. I was pulling a rolling suitcase with my left (typically my more painful) arm. When my left arm started hurting, I switched arms without thinking. It took me a moment to realize that now my right arm and shoulder were in terrible pain. I remember thinking that I had run out of spare arms, and that I was in trouble.

BTP occurs when patients with chronic pain who take a long-acting pain medication regularly, sort of “hit the wall;” their pain breaks through that dose of medication. This can happen when you develop a tolerance to the medicine they have been taking, making it less effective or effective for a shorter time. It can also result from a sudden movement, or with no obvious trigger.

In handling episodes of BTP, many doctors recommend taking a different, faster acting medication to help ease the symptoms. However, most analgesics take from 30 to 45 minutes to take effect, and patients undergoing cancer treatment may be too nauseated to take oral medication. New ways of administering pain meds, including a nasal spray and a pill that dissolves between the cheek and jaw, have nearly completed the approval chain and should be available soon.  Another comes as a “lollipop” which delivers a fast-acting dose of relief that is easy to take. These options seem to be fast-acting and well tolerated.

On that terrible night two years ago almost to the day, my empathetic husband drove me to the emergency room and I was given IV medication that helped a lot. Although he did everything he could to help me, I was glad he couldn’t really empathize with me that night. I would not want anyone to feel what I was feeling. I now carry a fast-acting medication with me all the time, so I never have to feel it again either.

For more info on breakthrough pain, I found these resources to be useful:

WebMD

breastcancer.org

discovery.com – end of life breakthrough pain

Tagged as: Analgesic, breakthrough pain, Chronic pain, Health, Medicine, Pain