Prevalence and characteristics of breakthrough pain in patients with chronic noncancer pain

Abstract

Breakthrough pain (BTP) has been well characterized in cancer patients1, but has received little attention in patients with chronic noncancer pain. We conducted a survey to evaluate the prevalence and characteristics of BTP in patients with chronic noncancer pain. Noncancer patients with controlled baseline pain (* moderate intensity) were identified at the investigator sites and were later surveyed by telephone about the characteristics of their pain using a BTP pain assessment algorithm originally designed for cancer patients. Seventy-three percent of patients surveyed (173/236) reported temporary flares of severe or excruciating pain (i.e., BTP). The most common diagnoses in patients with BTP were back pain (51%), cervical neck pain (9%), and complex regional pain syndrome (9%). Primary pain pathophysiologies in these patients included somatic pain (36%), visceral pain (5%), neuropathic pain (19%), and mixed pathophysiologies (40%). Twenty patients reported more than one type of BTP for a total of 194 different breakthrough pains and the following data are based on these 194 breakthrough pains. The median number of episodes per day was 2 (range <1 to 12). Median time to maximum intensity was 10 minutes (range 0 to 180 minutes) with 46% of the pains reaching maximum intensity within 5 minutes. Median duration of the pains was 60 minutes (range 1 to 720 minutes). Patients could identify a precipitant for 69% of the pains, and 92% of the precipitants were activity related. The onset of BTP could never be predicted for 46% of the pains and only sometimes be predicted for 30% of the pains. These results support the conclusions that BTP is common in patients with chronic noncancer pain, often has a rapid onset, has a relatively short duration, and is frequently difficult to predict, thus being similar to BTP in cancer patients. Supported by Cephalon, Inc., West Chester, PA.