title: National Breakthrough Pain Study: prevalence, characteristics, and associations with health outcomes.
abstract: The National Breakthrough Pain Study is a large observational study that assessed breakthrough pain (BTP) in a population of commercially insured community-dwelling patients with opioid-treated chronic pain. Eligible patients were identified from an administrative claims database, and consenting patients were asked to complete a structured telephone interview and several validated questionnaires. Questionnaires assessed pain interference with function (Brief Pain Inventory-Short Form), health status (Short Form 12 [SF-12] Health Survey), disability (Sheehan Disability Scale), work performance (World Health Organization Health and Work Performance Questionnaire), and mood (Generalized Anxiety Disorder-7 Screener [GAD-7] and Patient Health Questionnaire-2 [PHQ-2]). Of 2198 patients interviewed, 1278 patients had persistent pain controlled with opioid therapy; 1023 (80%) of these patients reported BTP. Patients had a median of 2.0 episodes of BTP per day (range, 1-50) and a median duration of BTP of 45 minutes (range, 1-720). Compared with patients without BTP, patients with BTP had more pain-related interference in function (Brief Pain Inventory, mean ± SD: 34.2 ± 15.6 vs 25.0 ± 15.7 [P < 0.001]), worse physical health (SF-12 physical component score: 29.9 ± 9.6 vs 35.1 ± 10.4 [P < 0.001]) and mental health (SF-12 mental component score: 47.4 ± 11.3 vs 49.3 ± 10.4 [P < 0.001]), more disability (Sheehan Disability Scale global impairment score: 15.1 ± 9.1 vs 10.6 ± 8.5; World Health Organization Health and Work Performance Questionnaire absolute absenteeism: 12.4 ± 59.9 vs 7.7 ± 44.9 hours [both P < 0.001]), and worse mood (GAD-7 score: 7.4 ± 5.9 vs 5.9 ± 5.4; PHQ-2 anhedonia score: 1.2 ± 1.1 vs 0.9 ± 1.0 [both P < 0.001]). In this population of community-dwelling patients with opioid-treated chronic pain, BTP was highly prevalent and associated with negative outcomes. This burden of illness suggests the need for specific treatment plans.
authors.affiliation: Teva Pharmaceuticals, Frazer, PA, USA Tufts University School of Medicine, Boston, MA, USA Analgesic Solutions, Natick, MA, USA EPI-Q, Inc, Oak Brook, IL, USA HealthCore, Inc, Wilmington, DE, USA Thayer County Health Services, Hebron, NE, USA MJHS Institute for Innovation in Palliative Care, New York, NY, USA.
authors.forename: Arvind
authors.initials: A
authors.lastname: Narayana
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Katz
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Shillington
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: Qing
authors.initials: Q
authors.lastname: Harshaw
authors.forename: Carla B
authors.initials: CB
authors.lastname: Frye
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059390:Breakthrough Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D015995:Prevalence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult