Managing breakthrough pain in mesothelioma
Many people with chronic pain from mesothelioma experience intermittent flare-ups of pain. These episodes occur even though the person is taking analgesic medications on a regular schedule for pain control. These flares of severe pain are called breakthrough pain because the pain "breaks through" the regular pain medication. If you take prescription pain medicine for on a fixed schedule and you also have occasional flares of intense pain, you may be experiencing breakthrough cancer pain .
Almost everyone with chronic mesothelioma pain should receive pain medications for around-the-clock pain control and also a medication targeted at breakthrough pain. If you do not have a medication for breakthrough pain, discuss this with your health care provider.
Generally, breakthrough pain from mesothelioma has a quick onset. It may last seconds or minutes, and sometimes hours. It can triggered by a specific activity, like coughing, moving, or going to the bathroom, or it can flare for no obvious reason. Most people who have breakthrough cancer pain experience several episodes a day.
If you frequently experience pain a short while before your next scheduled dose of pain medication, you may not be having true "breakthrough pain.” The pain may be an indicator that your dose or the frequency of the scheduled medication should be adjusted. This is something to bring up with your pain management team.
Opioids are the most effective medication for breakthrough pain. They are easy to take and fast-acting. Most people prefer medications that can be taken by mouth but these are not always fast-acting. Some people may not be able to take an oral drug due to difficulty in swallowing, nausea or other gastrointestinal problems. Breakthrough pain medications can be taken in other ways, including by injection, under the tongue (sublingual), rectally, or transmucosally absorbed in the mouth but not swallowed.
ACTIQ (Oral Transmucosal Fentanyl Citrate) is the first analgesic approved by the Food and Drug Administration specifically for breakthrough pain. It is the only analgesic (pain relief drug) that comes in the form of a lozenge on a handle, a lollipop for pain. Fentanyl, ACTIQ's active ingredient, is 100 times more potent than an equivalent dose of morphine. It dissolves in saliva, and is absorbed through the mucus membranes in the mouth. Pain relief occurs within 5 to 10 minutes. People find the drug easy to use, effective, and easily tolerated. Oxycodone and hydromorphone can also be used for breakthrough pain, but neither of these are available as lozenges in the mouth absorption.