“In the 18th century, the French philosopher Voltaire said, “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of which they know nothing….” He also opined that “…it is dangerous to be right on matters on which established authorities are wrong.” If he were alive today, writing a tome on pain medicine, it would be easy to imagine Voltaire describing physicians as people who withhold medications of which they know a great deal, to manage painful conditions of which they have learned even more, in human beings who perceive them as knowing nothing, amidst a regulatory climate that scares the hell out of them.
In the 21st century, it is ironic that although we have made significant advances in our understanding of how pain affects the nervous system and continue to develop innovative treatments, many pain sufferers, including dying cancer patients, receive little or no treatment. One possible explanation is the dizzying development of scientific theories of pain physiology, including the different subtypes of pain and the associated improvements in available treatment options, counterbalanced by increasing regulatory scrutiny and limited financial resources for some patients.
Breakthrough pain is a perfect example of the need to understand and treat all of the different pain subtypes. As is typical in pain medicine, breakthrough pain first came to the attention of clinicians in the cancer population. In 1990, Portenoy and Hagen proposed that transient flares of pain in a cancer patient with stable persistent pain treated with opioids be defined as breakthrough pain. However, breakthrough pain is neither specific to cancer pain, nor is it purely an opioid-related phenomenon. Cancer pain often is the catalyst for improving the nomenclature used to describe the different types of pain, and advances in opioid pharmacology often help to define these changes.” – Daniel m. Gruener, MD
Managing Acute Pain Episodes in Patients With Chronic Pain