An intermittent transient recurrence or exacerbation of severe pain in a patient who is taking regular analgesic medication and who has good pain relief most of the time. The essence of breakthrough pain is its unpredictability. The median duration is 30 minutes and the pain usually recurs in the same location.
Pain occurring at the end of the interval between regular analgesic doses indicates a need for an increase in the dose of morphine; this is not breakthrough pain
Most of the time, breakthrough pain can be managed with oral opioids. Supplemental doses of the same opioid (10-15 % of the total daily) doses are given to cover the brief pain exacerbation.
However, for breakthrough pain that is severe and sudden in onset, other routes of medication, such as transmucosal oral or nasal fentanyl, may be considered.
Thai V, Fainsinger RL, Chapter 7, Pain, In: Emanuel LL, Librach SL. Palliative Care – Core skills and clinical competencie, 2nd ed. St. Louis, Missouri, Elsevier, 2011.
Twycross R. Pain relief in advanced cancer. Churchill Livingstone, 1994. pp. 99-110.