Transiently worsening pain occurring as a direct and
immediate consequence of a movement or activity.
 Usually predictable, short in duration, and severe
 Good assessment important to identify
 Traditional analgesia regimens usually ineffective
Treatment
First, optimize the patients breakthrough dose and timing
• 10% total daily dose of opioid Q1h prn
• Provide PO dose 60-90 minutes before incident
• Provide SC dose 15-30 minutes before incident
If insufficient, consider NH Incident Pain Protocol page 164-165 NHPC Symptom Guide
• Sublingual Sufentanil
• very potent opioid, NOT for opioid naïve
• administer under tongue 10 mins prior to incident
• do not to swallow for 2 mins
• quick onset (3-5min), peak (10-15min), and short duration (40 min)
• Stepwise dosing (everyone starts Step 1, regardless of baseline opioid)
• Close monitoring required
• Proper labeling crucial to prevent errors
More information on the NHPC Program and registration forms can be found at www.northernhealth.ca. Northern Health’s iPortal Site:
iPortal > Clinical Resource > Palliative Care or contact your local Palliative Care Nurse Consultant or Regional Palliative Pharmacist.