• Daniel S Bennett, Steven Simon, Michael Brennan, and Steven A Shoemaker.
• Integrative Treatment Centers, Denver, Colorado, USA.
• J Opioid Manag. 2007 Mar 1;3(2):101-6.

ObjectiveWe sought to assess the prevalence and characteristics of breakthrough pain (BTP) in patients with chronic back pain.DesignResearchers utilized a telephone survey using a pain assessment algorithm. This report represents a subset of patients from a larger survey of 228 patients with chronic pain unrelated to cancer.ParticipantsThis study employed 117 subjects taking opioids for a primary diagnosis of back pain and receiving care at geographically dispersed pain treatment centers. Subjects had pain lasting at least six months and had "controlled" baseline pain.ResultsEighty-seven subjects (74 percent) experienced 93 types of BTP. The median number of BTP episodes per day was two; median time to maximum intensity was 10 minutes, and median duration was 55 minutes. Onset could not be predicted for 46 percent of pains. Eighty-three percent of subjects used shorter-acting opioids for BTP. Other medications used for pain included NSAIDs, antidepressants, anticonvulsants, skeletal muscle relaxants, intrathecal local anesthetics, and transdermal local anesthetics.ConclusionsThese patients with opioid-treated chronic back pain commonly experienced BTP, which often had a rapid onset and a relatively short duration and was difficult to predict. Opioids were the mainstay of pharmacologic therapy, but nonopioid analgesics and adjuvant analgesics were commonly used.

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