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Advances in Assessing and Managing Breakthrough Pain

Authors: Author: Scott M. Fishman, MD Medical Writer: Paula Moyer, MAFaculty and Disclosures

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Introduction

Breakthrough pain (BTP) remains inadequately treated despite many years of extensive national attention and education of physicians and other healthcare practitioners in the area of pain assessment and treatment. Currently, almost half of all Americans seek medical care each year for pain, making this problem the most common reason for physician visits in the United States.[1] Despite this high frequency of pain complaints, pain symptoms are too often neither recognized nor well controlled.

In some patients, pain assessed at the initial evaluation continues to exist on a chronic basis, reducing quality of life and social and occupational functioning,[2-4] often even after drug therapy is begun. Inadequate pain control has profound collateral consequences, such as psychological morbidity (including anxiety and depression)[1,3,4] and many other comorbidities (including insomnia, longer time to ambulation with associated pathology, and delayed recovery, as well as impaired respiratory function when the pain is associated with the chest wall).

Current studies suggest that BTP occurs in as many as 95% of all patients treated for pain, depending on the population surveyed and the definition of BTP used in the investigation.[5] In a survey of clinicians from 24 countries, BTP was reported in two thirds of all patients, with physicians from English-speaking countries significantly more likely to report BTP than those from other countries.[2] Although BTP is a widespread, heterogeneous phenomenon, its occurrence and causes are unpredictable in more than three quarters of patients, increasing the difficulty of BTP prevention and treatment.[3]