Treatment Planning

Acute Exacerbation of Chronic Pain

These are of two basic types:

  • Pain flare: Transient increases in pain that can last for hours to days. Flares are extremely common and generally benign although they may be perceived as harmful by the patient. Pain intensity eventually returns to baseline. Patients are encouraged to use behavioral and other nondrug techniques to manage flares. Care should be used with additional short-acting analgesics since they are not appropriate from a mechanistic standpoint and may only lead to escalated use of analgesics.
  • Disease progression: If pain is exacerbated and does not remit with flare management techniques, look for and treat any change in the causative disease process.

What about "Breakthrough Pain"?

Breakthrough pain (BTP) is a term first used to describe a transitory exacerbation of pain (predictable or spontaneous) that occurs on a background of otherwise stable pain in a cancer patient receiving chronic opioid therapy. The term is often over-used in clinical practice to describe any increase in pain; this can be confusing. Increases in pain may be categorized as incident related (i.e., caused by movement, cough, defecation, etc.), end-of-dose failure, or idiopathic. It is important to understand that all pain is dynamic and can fluctuate. Physicians should assess the characteristics of increases in pain in an attempt to identify its pathophysiology, predictability, onset, intensity and duration in order to apply appropriate treatment and differentiate between a pain flare or disease progression.