Prevalence and Characterization of Breakthrough Pain Associated with Chronic Low Back Pain in the South of Spain: A Cross-Sectional, Multicenter, Observational Study

Abstract

Chronic low back pain (CLBP) is highly prevalent in industrialized countries, where it is one of the main causes of disability. Patients with CLBP in treatment with opioids often experience episodes of breakthrough pain (BTP), but data on prevalence and treatment preferences are scarce. The objectives of this study were, first, the evaluation of the prevalence of BTP in patients with CLBP in the South of Spain (N = 1,868) and, second, the characterization of BTP in these patients (N = 295). Data was collected on presence of BTP, type and location of pain, treatment, compliance, and patient satisfaction. We found a prevalence of BTP in patients with CLBP of 37.5% (95% CI: 35.3%–39.7%), similar in men and women. 75% of the patients were older than 50 years. The preferred drug of patients who control BTP with opioids is fentanyl (78.3%) and its most common form of administration is nasal (53.2%). Therapeutic compliance was high and 46.3% of patients considered the control of their BTP very satisfactory. Our study showed that BTP is common in patients with CLBP and that current treatments seem adequate.

A rapid systematic review of breakthrough pain definitions and descriptions

“…Participants were adults with cancer (n = 26), adults or children receiving hospice care for cancer or other conditions (n = 1), 21 adults with chronic pain due to cancer or other conditions (n = 2), 9,22 and adults with chronic lower back pain (n = 1). 23 These were quantitative survey studies (n = 26) and qualitative interview studies (n = 3). [24][25][26] Only one study asked patients their views on the meaning of breakthrough pain.…”

“…This was not clearly stated in eight studies. 23 , 25 , 27 – 32 One 22 cited Portenoy & Hagen’s 1990 definition of breakthrough pain 33 as the inclusion criteria while five 24 , 26 , 34 – 36 used the diagnostic algorithm developed by a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. 7 The criteria for breakthrough pain in one study 37 were pain rated as ≥5/10 on a visual analogue scale.…”

“…Empirical studies with patients Location Across studies, patients indicated that they most commonly experienced breakthrough pain in their back. 9,[21][22][23]36,49 Other locations included head/face/ mouth, 9,21,22 abdomen, 21,22,24,25,36 leg(s), 9,[21][22][23]25 arm(s), 9,21,22 neck/shoulder(s), 9,21,22 glutes/hip(s) pelvis, 21,23,25 rectum or anus, 21 feet, 21 and ribs/ chest. 22,25 Severity In most studies, severity was rated on a 0-10 numerical rating scale.…”

“…Episodes typically lasted between 11 and 60 min though many patients experienced episodes of shorter or longer duration. 23,36,37,51,52,56 Average episode lengths included 30, 33,49 32.1, 54 40.6, 22 45, 9 47.5, 57 52, 21 60, 34,35 and 81.2 min 55 The average time to peak intensity ranged from <5 to 30 min 37 (including 1-2, 55 within 3, 33 10 9,34 or up to 10 min, 50 and 15 min) 35,49 but was most commonly 5-10 min 36,52,57 When asked to describe onset, more patients stated that their breakthrough pain had a gradual than a sudden onset in three studies 25,28,56 while the reverse was found in one other study. 22 Subtypes In seven reviews, 21,22,[34][35][36][37]49 patients' breakthrough pain was described as incident, spontaneous, or a combination, of which incident breakthrough pain was the most common followed by spontaneous.…”

“…22,49,57 Four studies classified incident breakthrough pain (from most to least common) into volitional, non-volitional, a combination, and procedural. [34][35][36][37] Patients' breakthrough pain was classified into nociceptive (somatic or visceral), neuropathic, or a combination in eight studies, 22,23,33,36,50,51,56 of which nociceptive or a combination was the most common.…”