Case studies in breakthrough pain

Objective. To illustrate the variable presentations of and treatments for breakthrough pain (BTP). Design. Five cases of BTP were selected by the author, and treatment options were then considered. Results. Breakthrough pain presents in many different ways in clinical practice. Clinicians must first evaluate patients to identify the subtype, etiology, severity, and pattern of BTP, and then use that information to suggest appropriate interventions. Whenever possible, correctable causes of BTP should first be addressed. A variety of treatment tools are available, including opioid analgesics, nonopioid analgesics, adjuvant agents, nonpharmacologic strategies, and procedural and surgical interventions. In many cases, more than one treatment option will be appropriate, but in all cases, regular communication between patient and clinician will be needed to achieve optimal control of BTP. Conclusion. Treatment of BTP should be individualized by using a multidisciplinary approach to address each patient's pain profile.