The importance of a word: how to translate ‘breakthrough’

Portenoy and Hagen defined breakthrough pain as a ‘transitory increase in pain to greater than moderate intensity, which occurred on a baseline pain of moderate intensity or less’. 1 Although the term ‘breakthrough pain’ includes a heterogeneous group of pains, it is widely used and usually its meaning is well understood by palliative care and pain specialists. However, there has been some difficulty in finding a translation of breakthrough pain in other languages, such as the Latin languages.2 The term ‘episodic pain’ was suggested to overcome that difficulty,2 but apparently it was not successful. Therefore, in those languages there are other words or expressions being used. For example, some years ago, ‘dor incidental’ (incident pain) was perhaps the term most commonly used to refer to breakthrough pain in Portugal. But ‘incident pain’ is not a good term for translating breakthrough pain, because this term refers to a subtype of breakthrough pain caused by an incident, such as a movement.1 In Italian, there isn’t a single word in use that is equivalent to breakthrough pain. One option in Italian is ‘dolore episodico intenso’ (Sebastiano Mercadante, personal e-mail), meaning ‘severe episodic pain’. In French, there is the same problem and ‘accès douloureux paroxystique’ is often used (Marilène Filbert, personal e-mail), meaning ‘paroxysmal painful bout’. The same problem certainly exists in other languages, both Latin and non-Latin ones. Since the end of the nineties, I have been using the word ‘irruptiva’ in Portuguese as a translation for breakthrough (‘dor irruptiva’ meaning breakthrough pain). In fact, that word means to penetrate or appear suddenly,3 a meaning close to breakthrough. Some time later in a meeting of the Research Steering Committee of the European Association for Palliative Care, I mentioned this to the Spanish doctor Juan Manuel Nuñez-Olarte, who also found the translation adequate and one that could be used in Spanish, and so he enthusiastically adopted it. Rapidly the term ‘dolor irruptivo’ spread among Spanish palliative care physicians. Nowadays, the terms ‘dor irruptiva’ and ‘dolor irruptivo’ are used in Portugal and Spain, respectively, by all doctors working in palliative care and pain therapy, probably without any knowledge of its source. Other Latin and non-Latin languages contain words similar to the Portuguese word ‘irruptiva’. However, those words may not be currently in use and are not even included in all dictionaries, but they exist. For example, the Italian word ‘irruttivo’ and the French word ‘irruptif’ have the same meaning as the Portuguese word ‘irruptivo’. However, when I tried to look them up in some Internet dictionaries, I was unsuccessful. Probably, the same is true with other languages. Although there may be some controversy regarding the definition of breakthrough pain and recognizing that the term is an umbrella that covers a heterogeneous reality, it is well established through use, and all palliative and pain doctors use and understand it. It is somewhat similar to the famous phrase, ‘though I cannot define an elephant, I can recognize one when I see it’. Therefore, a single word equivalent to breakthrough accepted in each language could be useful.