For people in chronic pain, sharp spikes of breakthrough pain can be a big problem. What causes it -- and how can you find pain relief? That's an important question for many patients, especially those with cancer.
"Breakthrough pain occurs when you're doing something that triggers extra pain, like getting up after knee surgery," explains Michael Ferrante, MD, director of the UCLA Pain Management Center. "Sometimes breakthrough pain just occurs, without any obvious trigger. In essence, it means the patient needs more medication to cover the chronic pain and another drug for the breakthrough pain."
An FDA advisory committee recently recommended that the FDA set certain limits on acetaminophen, a drug that is used in many prescription and nonprescription medicines to relieve pain and reduce fever.
Those limits could include taking off the market some prescription drugs, such as the painkillers Percocet and Vicodin, which combine acetaminophen with other active ingredients.
The reason for the proposed limits is the risk of liver damage from taking too much acetaminophen.
For those taking narcotics, breakthrough pain might be a sign that the body is developing tolerance to the narcotic, Ferrante says. "Tolerance means you need to take more of the drug over time to achieve the same pain relief."
When a patient develops a narcotic tolerance, the doctor can increase the dosage to provide the same pain relief -- but the risk of side effects gets higher with the higher dose, explains Salahadin Abdi, MD, PhD, chief of pain medicine at the University of Miami School of Medicine.
"Instead of increasing the dosage of that narcotic, a good solution is to change to a different narcotic," Abdi tells WebMD. "You can then use a relatively small dose of the new narcotic to get the same effect. You can switch to yet another narcotic later on if you need to."
Drugs called NMDA antagonists (N-methyl-D-aspartate) have been another advance in narcotics for pain relief, says Rollin M. Gallagher, MD, MPH, director of pain management at the Philadelphia VA Medical Center. NMDA antagonists block NMDA receptors to stop or minimize opioid drug tolerance.
"NMDAs allow us to provide pain relief with a lower dose of a narcotic drug," Gallagher tells WebMD. "Opioids are very effective, very safe, because they don't damage organs like other drugs do -- but you can develop tolerance. NMDAs can help prevent tolerance." Meaning less drugs and better pain relief.
Options for Breakthrough Pain Relief
With cancer pain, an extended-release morphine drug is often prescribed for the underlying pain. A faster-acting narcotic is used to treat the breakthrough pain, Ferrante explains. These are potent, immediate-release narcotics often referred to as rescue medications -- to "rescue the individual from that pain," he says.