BTP is a common cause of hospital admissions and accounts for 4.4% to 7.6% of readmissions. Patients with BTP have higher direct pain-related costs than patients without BTP ($1,080 vs. $750, respectively) and are approximately 2.5 times more likely to seek care in an emergency department than patients with chronic pain but without BTP.

All of the options for BTP can be used in the inpatient setting, but parenteral administration may be less applicable in the outpatient setting. Patients who might be appropriate candidates for parenteral opioid therapy in the outpatient setting include those who are highly motivated to comply with the regimen, are receiving a relatively stable dose [...]

Because the time from onset to peak pain intensity of BTP is generally only a few minutes and the average duration is one-half hour, the opioid that is used to manage most cases of BTP should have a rapid onset of effective analgesia and a duration of action appropriate for the characteristics of the BTP.

A primary goal of pharmacological treatment of BTP is to ensure that baseline persistent pain is treated effectively with around-the-clock (ATC) doses of an analgesic. If an immediate-release (IR) opioid is being used to treat the baseline persistent pain, the dose should be slowly tapered during conversion and titration of the ATC analgesic (opioid) dose. [...]

In addition to ensuring that primary treatments for the underlying cause of the pain are used to the extent that they are appropriate, clinicians should consider the utility of non-pharmacological treatments for the management of BTP. These therapies cover a wide variety of techniques, many of which are time-honored but have not been subject to [...]

INTRODUCTION The management of breakthrough pain (BTP) should be handled as a separate and distinct aspect of each patient’s pain syndrome. This approach allows the clinician to consider BTP as a therapy challenge separate from the patient’s baseline persistent pain (Figure 1). The treatment of BTP must be based on the individual patient factors uncovered [...]