Neurológia pre prax 5/2009

Breakthrough pain – clinical presentation and treatment

Breakthrough pain is one of the symptoms of tumorous pain. This term is not always used by physicians for the same symptom. The article presents the latest exact definition of breakthrough pain and mentions the states that are considered to be breakthrough pain but do not correspond to the current definition. Advanced stages of disease are a risk period for a progressive development of pain as well as breakthrough pain. Pathophysiologically, all kinds of pain are involved in breakthrough pain: nociceptive, neuropathic, and mixed pain. The speed of onset and duration of pain are essential data for breakthrough pain, which can range from several minutes to several hours and occur despite a well adjusted treatment of basic pain. Breakthrough pain has to be diagnosed correctly and treated with respect to the basic pain and the general condition of the patient. So far, treatment options have been limited to rapid-acting morphine that, however, lacks the characteristics required for this type of pain. Fentanyl sublingual or buccal tablets or nasal spray come closest to an ideal drug for treating breakthrough pain.

Keywords: breakthrough pain, opioids, transmucosal administration, nasal spray.