Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

doi:10.1111/j.1399-6576.2006.01154.x

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Wiley InterScience

Acta Anaesthesiologica Scandinavica

Volume 50 Issue 10, Pages 1290 - 1296

Published Online: 26 Sep 2006

Official Publication of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

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Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

J. Højsted ¹ , P. R. Nielsen ¹ , J. Eriksen ¹ , O. B. Hansen ² Per Sjøgren ²

¹ Multidisciplinary Pain Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen and ² Pain Clinic, Holbæk County Hospital, Holbæk, Denmark

Correspondence to Jette Højsted
Multidisciplinary Pain Center
Department 7612 Rigshospitalet
Blegdamsvej 9
DK-2100 Copenhagen Ø
Denmark
e-mail: hojsted@rh.dk

KEYWORDS

breakthrough pain • chronic non-malignant pain • opioids • pain intensity

ABSTRACT

Background: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment.

Methods: Patients were assessed at referral (T₀) and after a treatment period of 3 months (T₃) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T₀ to T₃ was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids.

Results: Thirty-three patients were assessed at T₀ and 27 at T₃. The prevalence of BTP declined significantly from T₀ (90%) to T₃ (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T₀ to T_3. The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS).

Conclusion: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.

Accepted for publication 11 September 2005

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1399-6576.2006.01154.x About DOI