Opioids in non-cancer pain: Breakthrough pain in patients with chronic noncancer pain: Impact on quality of life and the effects of oral transmucosal fentanyl citrate

Abstract

The aim was to provide a qualitative evaluation of the effects of breakthrough pain (BTP) on quality of life (QOL) in patients with chronic noncancer pain and a subjective assessment of the ways in which oral transmucosal fentanyl citrate (OTFC®, ACTIQ®) affects QOL. A structured assessment was conducted in 43 patients using OTFC and long-acting opioids whose pain intensity scores (numerical scale, 0=no pain to 10=worst imaginable pain) met the definition of BTP, namely transient flares of pain of moderate to severe intensity with persistent pain of moderate or less intensity (≤7) when controlled with around-the-clock opioids. Patients rated the impact of BTP and OTFC on QOL(0=not at all, 1=a little bit, 2=somewhat, 3=quite a bit, and 4=very much). The 43 patients had a mean (range) age of 49 (36-71) years; 75% were female. The most common primary pain diagnoses were back pain (53%), musculoskeletal pain (16%), fibromyalgia (16%), and headache (12%). Mean (range) intensity of persistent pain was 4.7 (0-7) and of BTP without OTFC was 9.0 (5-10). Patients reported experiencing a mean of 6 BTP episodes/day (median=4, range 1-50), each episode lasting a mean of 89 minutes if untreated. Patients' mean ratings of time to meaningful pain relief of BTP were 40 minutes using short-acting opioids and 15 minutes using OTFC. Highest mean scores for adverse impact of BTP on QOL domains were: ability to work (3.4), financially (3.3), enjoyment of life (3.2), sleep (3.2), and mood (3.1). Highest mean scores for improvement with OTFC were: enjoyment of life (3.1), general activity (2.9), and mood (2.9). BTP in noncancer pain patients adversely affects many domains of QOL. OTFC provided rapid relief of BTP and improvements in QOL.