Breakthrough Cancer Pain Tracker
What is breakthrough cancer pain (BTCP)?
Breakthrough pain happens even though you
are taking pain medicine regularly for your
constant pain. It’s called breakthrough pain
because it “breaks through” the pain relief
you get from your regular pain medicine.
Breakthrough pain episodes often come
on quickly, and without warning. You may
experience several breakthrough pain
episodes a day, which typically last around
30-60 minutes each. But, they can last up to
240 minutes.
Why is it important to track
breakthrough pain?
Use this Tracker and begin recording your
breakthrough pain episodes. We recommend
tracking your breakthrough episodes for
one week because it may help you and your
healthcare provider see a pattern to your pain.
Sharing this information with your healthcare
provider will help them learn more about your
pain, how well it is being managed, and what
treatment changes may be necessary.
The Tracker will help you record
valuable information about your breakthrough pain.
When filling out the Tracker, be sure to note:
• The date and time of the episode
• What, if any, activity caused the episode
• How bad the pain was at its worst
• Where you felt the pain
• What the pain felt like
• What medication you took to manage the pain,
and how much
• How quickly the medication began to work
• How well the medication relieved the pain episode
• Any notes about the episode or questions
for your healthcare provider
If you are not satisfied with your pain relief, please talk
to your healthcare provider.
Breakthrough Cancer Pain Tracker
Date
Time
1 1 /3 / 13
6 :15
AM or PM
Was Pain
Episode Related
to Activity?
0
Y or N
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Walking to get
newspaper
on driveway.
0
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Location of Pain
0
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Fentanyl
Spray
100 mcg
total dose
5 minutes
Fentanyl
Spray
200 mcg
total dose
5 - 10
minutes
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes: I noticed that the pain moved from my hip to my knee.
1 1 /3 / 13
6 :45
AM or PM
0
No it just
Y or N
happened
without
warning.
0
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
0
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes: One dose was not sufficient so I took another dose after about half an hour. I’ll begin with 2 next time.
Take your medication as directed. The above examples are for illustration purposes only. Only increase your dose as instructed by your healthcare provider.
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Date
Time
/
/
Was Pain
Episode Related
to Activity?
Y or N
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Date
Time
/
/
Was Pain
Episode Related
to Activity?
Y or N
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Date
Time
/
/
Was Pain
Episode Related
to Activity?
Y or N
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Date
Time
/
/
Was Pain
Episode Related
to Activity?
Y or N
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Date
Time
/
/
Was Pain
Episode Related
to Activity?
Y or N
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
Y or N
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
/
:
Y or N
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Notes:
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Breakthrough Cancer Pain Tracker
Was Pain
Episode Related
to Activity?
Date
Time
/
Y or N
/
:
Level of Pain at its Worst
(0 = No Pain and
10 = Worst Possible Pain)
Location of Pain
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Pain Description
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
When Did You
Breakthrough
First Feel the
Pain Medication
Medication
(Total Dose) Used Begin to Work?
(in minutes)
Level of Pain After Taking
Medication
(0 = No Pain and
10 = Worst Possible Pain)
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
Y or N
/
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
Y or N
/
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
Y or N
/
:
0 1 2 3 4 5 6 7 8 9 10
No
Pain
AM or PM
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Notes:
/
Y or N
/
:
AM or PM
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain
Front
Back
Aching Intense Stabbing
Burning Numb Stinging
Cramping Radiating Tender
Deep Sharp Throbbing
Dull
ShootingTingling
ElectricOther:__________
Notes:
©2013 INSYS Therapeutics, Inc. All rights reserved. SUBSYS® is a trademark of INSYS Therapeutics, Inc SUB-14-1187 Feb 2014 Printed in the USA.
0 1 2 3 4 5 6 7 8 9 10
No
Pain
Moderateto-severe
Pain
Worst
Possible
Pain