There are three classifications of chronic pain: intermittent, persistent and breakthrough pain. There are also two different forms of pain medications: short acting and long acting opioid medications.
Persistent or constant pain is characterized by pain that lasts for 12 or more hours every day. The pain is usually treated with medicines that last around the clock, such as long acting opioids, adjuvant medications and with non-drug therapies. This form of pain is common with chronic pain. For patients with chronic pain, the classic approach is to convert the patient from short-acting opioids to long-acting/sustained release opioids, because long-acting opioids provide less fluctuation in analgesic blood levels, fewer adverse effects, and require less frequent dosing.
Intermittent pain is characterized as episodic and may occur in waves or patterns. Intermittent pain is typically treated with non-drug therapies and a short course of adjuvant medications, such as NSAIDs. However, intermittent moderate to severe pain may be treated with short-acting opioids. Intermittent pain is usually not persistent. It is possible to have both persistent pains, such as chronic low back pain, in additional to intermittent pain, such as acute migraines. Breakthrough or sudden pain is characterized by a flare-up or a break through the relief provided by an around the clock pain medicine regime used to treat persistent pain. Non-drug therapies, adjuvant medications and occasionally short-acting opioid medications can be used to treat breakthrough pain. We recommend that short acting opioids to treat breakthrough pain be limited to no more than four doses a day. By limiting the number of short acting medications that you take in a day, you will decrease the risk of tolerance over time, as well as have a more stable pain regimen. Tell your doctor if you are having more than four breakthrough episodes a day, as this may require an adjustment of your pain regimen or the additional of additional treatment options to minimize these breakthrough episodes.