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The Oxford American Pain Library provides practical guides that cover current approaches and new developments in the assessment and management of pain. The Diagnosis and Treatment of Breakthrough Pain is meant for doctors and nurses but can also provide some insight into treatment options for patients suffering from uncontrolled pain flares. In the excerpt below we learn what breakthrough pain really is.

The term “breakthrough pain” began appearing in the medical literature in the 1980s on the heels of the increased attention, brought about by the World Health Organization, to the global problem of undertreated cancer pain. During that time, it became apparent that cancer patients commonly experience intermittent exacerbations of severe pain against a background of continuous, or baseline, pain. Episodic pains that would “break through” during the treatment of background pain that was otherwise well controlled through the use of around-the-clock opioid therapy were catergorized by Portenoy and Hagen (1990) in a seminal work titled “Breakthrough pain: Definition, prevalence and characteristics.” The definition of breakthrough pain proffered in that article took root and has been used in pain management parlance ever since.

As opioid therapy has become more commonly used in the treatment of chronic noncancer pain over the last decade, it have become equally apparent that similar patern of supervening severe pain episodes can confound otherwise well-managed chronic pain (Seppetella et al., 2001). Recognizing the similarities of sympotms, independent of underlying pathophysiology, a group of pain managment experts came together in 2006 to create a unifying definition, based on a review of all the literature on the subject in all populations studied to date. The more generalized definition incorporates the additional observation that breathrough pain seriously disrupts the quality of patients lives. Therefore, the term breakthrough pain is now categorically determined to define the particular clinical circumstance wherein patients who have controlled baseline pain experience severe episodes of pain that breaks through the medical therapy (usually opioids) that has relieved the baseline pain.

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In Fibromyalgia: An Essential Guide for Patients and Their Families, Daniel J. Wallace M.D. and Janice Brock Wallace, provide advice for the nearly six million Americans who suffer from fibromyalgia. The book explains all the symptoms, signs and treatments in accessible language and offers accessible guidance for living with this syndrome. Below is some advice about exercise.

What Is the Best Kind of Exercise for Fibromyalgia? (more…)

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Mother's Day had its beauty--sunshine, a lovely church service, my daughter's original poem. I prepared a scrumptious brunch and the world seemed totally right. I even got to take a nap. And then the downside of life started--a slow slide into unexpected pain. My left hip started twinging, and by evening, I couldn't walk without excruciating pain.

I went to the ER, where everyone wished me a Happy Mother's Day. Better yet, I got a painkiller so I could at least answer questions, and after two hours, I had a diagnosis (nothing serious), a prescription for painkillers and muscle relaxants, and a wheel chair ride back to the car for the trip home.

It's amazing how I take everything for granted but as soon as it's gone (even temporarily), I suddenly realize just how valuable it is--like walking, bending, sitting, even rolling over in bed--when you can't do those basic things they suddenly seem like the most important things in the world. They aren't, of course--to my daughter, my friends and my co-workers who all pitched in to help me through Sunday and the next two days--thanks. People are the most important. Still, I'm glad that I can now sit down and stand up (even if there's still pain, it's not the excruciating, can't do it kind of pain, just the unpleasant, discomfort, occasional-twinge kind of pain.

And I'm hoping to go back to work tomorrow. It's no fun to be home when all you can do is hope to lie down and be able to get back up again!