Breakthrough Pain

Breakthrough pain occurs between regular doses of analgesia; it reflects an increase in pain level beyond the control of the baseline analgesic.

In this situation the patient should be given an additional, or breakthrough, dose of their regular opioid.

The breakthrough (BT) dose ordered should be one-twelfth to one-sixth of the total daily dose (10% of the background dose is a simple approximation). The patient should be instructed to take the BT dose as often as necessary to control the pain. BT doses should be given no more frequently than every 30 minutes.

The regular analgesic dose should be reviewed if BT pain is not controlled after 3 doses.

The regular dose of opioid should be taken at the scheduled time.