DrugBuyers.Com: Please Explain Breakthrough Pain Medication, Plea

This will sound strange, but I don't belive what you are feeling is the "classic definition" of breakthrough pain, yet you do still need breakthrough pain medication.

What breakthrough pain is, is a sudden, uncommon and excrutiating pain that generally comes with no warning to users of long-acting opioids. Cancer is nearly always the cause. If you take your long-acting meds and say three or fout hours later they stop working, that is not brealthrough pain. That is just medication failure. If you long-term medication is simply not strong enough and you feel pain when you shouldn't that too is not breakthrough pain.

Breakthrough can best be described as a sudden flare or searing pain that completely overwhelms long-term pain meds. Let's look at it in the case of Fentanyl. This is given in a long-term patch with one dose being 100mcg/hour. A common med for breakthough of that medication would be the 600mcg Atiq lollipop. What that means is for a cancer patient with painful cancer such as bone cancer, her pain is generally held in check with 100mcg per hour. When this flares or breaksthrough she may need 600mcg in 15 minutes. That is alot of medicine and even someone terminal and used to strong meds, they could not handle that high of a dose over time. This type of pain could be called suicide pain because it's so bad and so quick, so it must be treated very hard and very fast.

Now you still need a "breakthrough med" when you are being prescribed long-term pain meds, even if you don't have the classic breakthrough pain. Say you take 80mg oxy once every 12 hours. If you have a lot of pain one day and it's just not cutting it, you can't just double up and take another, for one thing the dose is released over 12 hours and you're just worried about a few hours. Another thing is your doc and your prescription company will assume 60 tabs will always last a month so if you double up when the pain gets bad you will run out. In this case you simply need a shorter acting pain med, yet you would not need the super strength med used for cancer breakthrough.

If you are taking 40mg of oxy every 12 hours, your doc should write for 30 oxy-IR per month as well. This would give you 5mg of oxy (and no fillers) in an immediate release (IR) form. When you are taking a 40mg oxy that gives you 3.5 mg every hour, when you need a little extra, you take a IR which basically doubles your dose for one hour only (not the full 12 hours).

Since your pain cannot possibly be constant over 12 hours, or with the patch over 72 hours, you will always need access to meds to help when the pain breaks through.

Good luck. As usual, sad as it seems, we need to educate the Docs because they just don't understand.

Farmer