Breakthrough pain varies from patient to patient, and so there is no standard way of treating this type of pain. Every patient needs a full assessment in order to determine the best options for treatment of their breakthrough pain. The aims of treatment are to reduce the number of episodes, the severity of episodes, and the interference with daily activities (without causing significant side effects).

The choices for treating breakthrough pain include:

• Treat the underlying cause of the pain
• Increase the dose of regular painkiller
• Start another regular painkiller
• Start a painkiller to take when the pain comes on (so-called “rescue medication”) – this is the most common method of treating breakthrough pain
• Start a non-drug treatment to use when the pain comes on
• Nerve block / other specialist treatments
• A combination of these options

Most patients require a painkiller to take when the pain comes on (“rescue medication”). Many patients are treated with similar drugs to those that they take to control the background pain (e.g. morphine, oxycodone). However, these drugs may not be as effective in treating breakthrough pain due to their slow onset of pain relief.

Several drugs have been developed to specifically treat breakthrough pain; these new drugs have a number of advantages over older drugs (particularly their faster onset of pain relief), but these new drugs are not suitable for all patients with breakthrough pain.

Currently, the drugs that are licensed to treat breakthrough pain are:

• Abstral®
• Actiq®
• Effentora®
• Instanyl®