Numeric Rating Scales for Breakthrough Cancer Pain

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Numeric rating scales can be utilized to assess the severity of breakthrough pain for patients with cancer, notes Jeffrey A. Gudin, MD. However, in addition to numerical tools, daily activities and medical history should also be considered, such as whether the patient is at the end of the dose or has undertaken new activities, notes Charles E. Argoff, MD. Adding these questions to the assessment will provide an accurate measure of the events leading to the breakthrough pain.

If the patient is reaching the end of a dose, the long-acting analgesic may be wearing off causing breakthrough pain, adds Gudin. Moreover, if there is a correlation between breakthrough pain and a strenuous activity, such as exercise, proper preventive measures like fast-acting pain medications can be used to avoid the event, Argoff states.

This assessment is particularly relevant in patients with cancer, since breakthrough pain could be a direct result of the treatment they are receiving, notes Marc Rappaport, DO. As a result of the variation in cause, the treatment approach should also be different for patients with cancer, adds Rappaport.