Rachel Lozano is something of an expert on how to survive cancer. As a teenager, the now 26-year-old art therapy student from St. Louis was given no chance of surviving a recurrence of her Askin’s tumor—a rare kind of neoplasm in the tissues of the chest wall. Yet she has beaten those odds—three times—and now she’s in remission. Five years cancer-free doesn’t mean she’s scot-free, however. Lozano still suffers regularly with sudden flare-ups of severe pain, known as breakthrough cancer pain. “It affects my entire body, causing excruciating pain in my back, arms, legs, neck and intestines when I’m at school and even when I’m sleeping,” she says. “The severity of pain often prevents me from sitting in my chair in class and disrupts my sleep—I never feel well rested.”

Lozano isn’t alone. As many as two-thirds of people with cancer-related pain also experience episodes of breakthrough pain similar to hers. And a new survey from the American Pain Foundation (APF) shows that three out of four U.S. adults who battle with breakthrough cancer pain like Lozano’s say it’s one of the most challenging aspects of having cancer.

Unlike persistent pain that builds gradually and lasts at least 12 hours a day—what’s sometimes called background pain—breakthrough cancer pain is intense and incapacitating. It has a fast onset, sometimes triggered by simple movements like dressing or sneezing, and a short duration, usually 30 to 60 minutes. It’s called breakthrough, because the intermittent pain is so powerful it “breaks through” regular pain medications.

“We’re not talking about minor aches and pains,” explains Will Rowe, APF’s chief executive officer. “These severe flares of pain often strike without warning, leaving many people fearful of the next crippling episode and unduly burdening patients and their families.”

Survey Results
In October 2009, APF canvassed 545 adults, ages 18 and older, who have been diagnosed with cancer, take medicine to control their cancer pain, and experience these sudden, momentary bouts of pain. Some results follow.

* More than half of participants rated their pain an eight, nine, or 10 out of 10 (10 being the worst pain imaginable).
* Three out of four are woken from a deep sleep at least once a month because of their pain.
* 76 percent said that breakthrough cancer pain affects their ability to perform everyday household chores.
* 83 percent said it stifles their desire to participate in certain activities.

While more than half of those surveyed said their healthcare provider had described breakthrough cancer pain as a normal side effect of cancer or cancer treatment, it causes extraordinary levels of financial hardship. More than half of participants take more medication and visit their doctors more often, contributing to higher daily medical expenses and increased medical-related debt.

Battling breakthrough cancer pain is a particular challenge, says Russell K. Portenoy, M.D., chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York and an APF board member, “because it occurs even when a patient is taking the right dose of medication on a regular basis.” One thing is certain, says Portenoy, “patients should not accept breakthrough cancer pain as a normal side effect of cancer. More studies are needed to determine the most effective treatments to alleviate this pain.”

Treatments
Experts say the ideal medication to treat breakthrough cancer pain would be

* Easy to take
* Fast acting
* Quick to leave the body after pain subsides

Currently the most popular medications used for breakthrough cancer pain are opioids like oxycodone and hydromorphone, typically prescribed in pill form. The trouble is oral medications like these can take 20 to 30 minutes to provide relief, according to a 2009 European survey of breakthrough cancer pain that was presented in September at the European Federation of Chapters of the International Association for the Study of Pain. And for people experiencing nausea or other gastrointestinal problems from their cancer therapies, oral medications are even more challenging.

Actiq (oral transmucosal fentanyl citrate) is the only analgesic to be approved by the U.S. Food and Drug Administration for the specific treatment of breakthrough cancer pain. It comes in a lollipop that dissolves through the thin membranes in the mouth and provides pain relief in 5 to 10 minutes.

Some breakthrough cancer patients have found relief using cognitive therapies like relaxation, hypnosis, guided imagery, and distraction.