Breakthrough pain is well-characterized in cancer patients but not in patients
with chronic noncancer pain. The investigators recruited 228 patients with various
types of chronic noncancer pain from 9 pain programs and administered a telephone
questionnaire with a breakthrough pain assessment algorithm originally designed
for cancer patients. All patients had controlled baseline pain, and 168 (74%)
experienced severe to excruciating breakthrough pain. Among those with breakthrough
pain, the most common syndrome was low back pain (52%), and the underlying pathophysiology
was variably characterized as somatic (38%), neuropathic (18%), visceral (4%),
or mixed (40%). A total of 189 different types of breakthrough pain were reported.
The median number of episodes per day was 2. Median time to maximum intensity
was 10 minutes. Median duration of the breakthrough pain was 60 minutes. Patients
identified a precipitant for 69% of pains; 92% of these were activity-related.
Onset could never be predicted for 45% of pains and only sometimes predicted
for 31% of pains. Breakthrough pain was highly prevalent and varied in this
population. Further studies are needed to clarify whether the clinical impact
and therapeutic challenges posed by this phenomenon are comparable to the cancer
population. This study suggests that breakthrough pain is highly prevalent and
varied in opioid-treated patients with chronic noncancer pain. Portenoy RK,
Bennett DS, Rauck R, Simon S, Taylor D, Brennan M, Shoemaker S. Adapted from
J Pain. 2006 Aug;7(8):583-91.
PMID: 16885015
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the
National Library of Medicine (NLM).
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