Managing Break Through Cancer Pain (BTCP)

When it comes to managing cancer pain, it is important to take time to consider the various options that might work best for you or your loved one. There are many factors to consider that sometimes might get overlooked until we find our loved one so sedated from pain medication that all they can do is sleep. Pain medications are strong, they act differently with different people and may leave some people feeling better, but so out of it that they can’t concentrate, or the person may be confused, drowsy or feel intoxicated.

The key is to find a way to manage pain and also to try to help the person stay alert enough to enjoy their lives and the activities that have meaning for them. We also want to anticipate any pain flares or what’s known as “Breakthough Pains.”

Break Though Cancer Pain

These are often described as intense bouts of pain that occur when a person is already on a routine of regular prescription pain relief medications. This is often seen with opioid-based painkillers, like those containing codeine, morphine, or oxycodone.

Break through cancer pain is just what you’d expect, it comes on suddenly and doesn’t respond well to the person’s normal pain medication.

Although rapid and fast-acting opioid intravenous medication or nerve blocks can be used to reduce pain intensity in hospital settings, many people with cancer pain are at home and are looking for relief from these break through flares.

When considering what to do for a loved one who may be suffering from cancer pain, it’s important to talk to them about what they want at multiple points in the journey.

Renowned surgeon, writer, and public health researcher Atul Gawande’s recent book Being Mortal discusses some of the important questions you should consider when caring for loved ones who have cancer pain and in particular if you are faced with end-of-life care. Dr. Gawande shared his experiences from his own father’s battle with terminal brain cancer.

He suggests asking:

• What their understanding of their disease is 
• What quality of life they would like to have now and in the future
• How they envision their passing
• Would they like to be alert and willing to put up with some pain
• Would they like to have a completely painless passing
• What things do they want to experience before their passing that are important to them
• What does a good day look like?

While some patients wish for a peaceful, painless passing, others are willing to put up with some pain in order to maintain a certain level of alertness so they can be with their family or do things that are important to them. These difficult questions should be discussed as disease progression occurs because, quoting Gawande, “What I realized is, we were not really talking about death or dying. We were really talking about, how do you live a good life all the way to the very end, with whatever comes?”

Keeping in mind what is important to the person, and what goals they hope to achieve in their final days can help you create a plan and feel as though their final wishes are being met.

I’ve been privileged to help care for many friends and family members who were facing the end of their lives. Having discussions about pain, pain management and how alert they’d like to be were very much top of mind for all of them and they welcomed the open discussion so they could be better prepared.

When it comes to break through cancer pain, you’ll want to get advice from your hospice and palliative care providers so that you can have many tools in your tool box and find the Gold-i-locks solution that’s just right for the person.

I’d like to know what your experience has been with break through cancer pain and end-of-life discussions.