Breakthrough Pain

With chronic pain, there is no such thing as “cure” - only management. often it takes months, even years for the docs to devise a plan, by which one can at least live with the pain. the pain itself becomes a way of life, and one tries, as best one can, to get on with things. we learn limits. some things will be no longer within our reach, but we can live without them. the word “acceptance” becomes a key.

We can learn new skills, and through this begin to create new hopes, dreams and aspirations. by wanting less, we gain more.

The specialists have had their way. our minds have been conditioned by the psychologists, while our bodies toned by the physiotherapists. social workers and occupational therapists have identified our needs, and, to the best of their limited resources, attempted to fill them. one by one, the doctors have made their contributions, trying this drug, adjusting the dosage on that, (often while our minds lose track of whom and what we are.) we have even tried “self-medicating” by increasing and decreasing dosages, or testing others, (legal or otherwise) and now we are being slowly weaned out of the “system.” there are others waiting to take our place. it would seem that all that can be done has been done, and now, bit by bit, we are being left to our own devices. we are gifted with a care plan, words of praise and encouragement - even a kind smile, and discharged into the wilderness of self-care.

We are not cured, but we have been carefully taught to live with the disability, and move on. we can now manage our pain, and having achieved that, the work of the health care professionals is complete. if we are lucky, we will receive an outpatient's appointment set for three months away. (funding restrictions prevent anything sooner) and referred back to our own g.p. for prescriptions and the like.

Mission accomplished! the pain is under control. we are under control. it is now time to move on to the next patient. according to the reams of charts and records, we are now safe.

however, the truth is, we are not safe at all. there is more to come. a lot more.

welcome to the world of “breakthrough pain!”

what is “breakthrough pain?” effectively it's a sudden onset of unexpected, and usually much more aggravated pain. put simply, our pain seems to be under control, and we are managing within the limits it imposes upon us - and then wham! suddenly the pain becomes much worse, seemingly without reason. when this happens, most people tend to panic. breakthrough pain only applies when the cause for the chronic pain is already been diagnosed, and is under treatment. it may even seem to be in a different part of our body. the important issue is that it hurts a lot, and the sufferer was not expecting it to happen. what is happening, is that the pain is suddenly over-riding the medication designed to control.

when this happens, the sufferer needs help from a clinician who is already fully aware of both the patient and the current treatment plan. never attempt to treat breakthrough pain by increasing your current medication or taking something not prescribed by your regular doctor. such an action may well kill you!

however, you may find that help is difficult to obtain. your clinician will be very cautious about what medications he/she is willing to prescribe. a doctor who doesn't know your complete history will almost certainly refer you to a specialist, and send you away. going to the emergency department at a hospital is a complete waste of both your time, and theirs. this is because, again, they are not fully informed about your condition, and current treatment. (don't expect an e.d. doctor to take your word on the matter). also these doctors spend a good deal of their time dealing with addicts presenting with “major pain symptoms” in an effort to obtain narcotic drugs. it is highly unlikely you will receive more than a cursory examination, - and you will, most likely wait hours before you get even that.

the answer is to see your regular physician as soon as possible. he/she is really the only person in possession of all the facts from which a quick, accurate, and effective treatment plan may be instigated.

the good news is that “breakthrough pain” can often be avoided. the secret may seem like a two dollar answer to a hundred dollar problem, but it does work, and moreover you will feel better, overall, for the adoption of the technique. in my coming article, “use it or lose it, I'll tell you all about it. in the meantime, try to keep in mind that “breakthrough pain” is seldom long lasting. hang in there, help is at hand. remember that i am a chronic pain sufferer too, and I'm still here to write this!