How do you know if you need a breakthrough med? - Pain Management Message Board

mnmama · 08-03-2008, 08:32 AM

I was just switched to Morphine Sul 100 MG every 8 hours. How do I know if I need a breakthrough pain med or just a higher dose extended release med?
Thanks

cmpgirl · 08-03-2008, 09:42 AM

This one is a bit tricky. A BT med is generally prescribed when you need some additional relief, due to activity. Say for instance, you get pretty good pain coverage (5 or less on the pain scale) most of the time, but when you have flare ups or spikes in your pain from doing certain physical activities, you may need an occasional "boost" in meds.

Some docs are of the mindset that a LA med, such as the MSContin, should cover all of your pain sufficiently and no BT should be necessary. Other docs feel that because we all have our day to day lives to live and are bound to have episodes of BT pain, a limited dose of BT meds is needed.

I would say that if your LA meds are doing a good job, overall, but you are having episodes or flares on a daily basis, you might need a BT med. But, as I said, it really depends on how your doc sees it. I think this would be a really good way to open a dialog with your doc.

In short (too late! lol) If you are having constant episodes of BT pain, then you should let your doc know and see if he/she is open to Rx'ing a SA med.

Hope this helps. Take care, CMP/MM

Executor · 08-03-2008, 09:44 PM

Quote:

Originally Posted by cmpgirl

I would say that if your LA meds are doing a good job, overall, but you are having episodes or flares on a daily basis, you might need a BT med. But, as I said, it really depends on how your doc sees it. I think this would be a really good way to open a dialog with your doc.

Cmpgirl is exactly right in her excellent reply. BT meds are for "flare ups" or periods where the pain increases beyond it's normal range. These "flare ups" are very typical in CP patients and this is why most PM Docs prescribe BT meds. As Cmpgirl said, there are some varying thoughts or theories on the subject, and this is what makes PM so difficult and unique in nature.

I think it's fair to say that most PM Docs today don't believe that one's LA med will address all of your pain. Pain is unpredictable and doesn't always cooperate. The purpose of a LA med is to deliver med to your system 24/7 as a "baseline" where your BPL (blood plasma level) is @ some fixed level. This "baseline" level accomplishes two primary things:

(1) Eliminates, or significantly reduces, the "ups & downs" of short acting pain meds. Due to their nature, SA meds (such as Vicoden, Percs, & etc) are released all @ once and then are eliminated). In the short run, this is fine for pain control as the med will last for a good while....Sometimes as long as 6 hours. Additionally, until physical dependance occurs, your body doesn't really "miss" the med after it leaves. Over time, however, the amt of time the med lasts, gets shorter and shorter, and invariably, physical dependance sets in. Consequently, this is when the "ups & downs" start to occur. The med (and BPL) is up and down like a yo-yo, thus, causing lots of issues.

(2) LA meds, or a steady state of med, will address a lot of the minor or low level pain. In many cases, the patient won't even feel it due to the meds in their system.

Unfortunately though, almost all of us have "flare ups", or times when the pain gets rough. This is where the BT meds kick in. The BT meds are usually SA in nature, and target those "flare ups" with a immediate release of med (either the same as the LA or a different med).

I'm of the thought that over the long run, LA meds change your "baseline" to where they aren't all that effective anymore. if this happens, you have one of two choices....(1) Increase your BT med in either strength or frequency, or (2) Increase you LA med. Sometimes, a Doc will do both @ the same time.

My Doc doesn't believe in high levels of LA meds because he thinks it raises your physical dependance, and overall set point needlessly. He thinks that you should only take meds when you need them, thus, he'd rather have you on a lower LA med and give you more access to BT meds, than vice versa. Again, every Doc has his/her own theory.

Hope this helps explain the X's and O's of BT meds.

Good luck.

Ex