Open Access Open Access  Restricted Access Subscription or Fee Access

Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, Part 2: Impact on function, mood, and quality of life

Russell K. Portenoy, MD, Daniel Bruns, PsyD, Bonnie Shoemaker, BSN, Steven A. Shoemaker, MD


Background: Prior studies of breakthrough pain (BTP) largely focus on patients with advanced cancer or those receiving inpatient care. Very few studies have evaluated BTP in populations with chronic noncancer pain. Data that illuminate the impact of BTP may not generalize to other, less selected patient populations.
Aim: The aim of this study was to evaluate the impact of BTP in opioid-treated ambulatory patients with chronic cancer pain or noncancer pain treated in community practices.
Methods: Eligible patients—those with any diagnosis who reported chronic pain for at least 3 months, who were receiving long-term opioid therapy, and who met criteria for controlled baseline pain—were recruited for a cross-sectional observational study by primary care physicians or community-based oncologists at 17 sites in the United States. The patients responded to a structured interview for breakthrough pain and also completed the Brief Pain Inventory-Modified Short Form (BPI-SF) and the Brief Battery for Health Improvement 2 (BBHI 2).
Results: Of 355 patients screened, 191 were eligible and 177 (93 percent) provided data for analysis. Twenty-six of the 78 with cancer pain (33 percent) and 48 of the 99 with noncancer pain (48 percent) had BTP. Compared with those without BTP, both patients with cancer (p = 0.004) and patients without cancer (p = 0.019) with BTP had increased pain interference in function, as measured by the BPI-SF, and patients without cancer were more impaired than patients with cancer. On the BBHI 2, BTP was associated with increased somatic complaints (p = 0.036 cancer and p = 0.024 noncancer) and pain complaints (p = 0.037 cancer and p = 0.037 noncancer); among patients without cancer, BTP was also associated with increased difficulties with functioning (p = 0.023), depression (p = 0.039), and decreased quality of life (p = 0.003).
Conclusions: These data extend published observations about the association between BTP and adverse effects on mood and function to populations undergoing routine treatment in the community setting and provide evidence that these associations are greater in those with noncancer pain. They suggest the need for additional studies to clarify causality and determine whether undertreatment of BTP is a factor contributing to adverse pain-related outcomes.


breakthrough pain, chronic pain, functional impairment, psychological distress

Full Text:



Portenoy RK, Hagen NA: Breakthrough pain: Definition, prevalence and characteristics. Pain. 1990; 41(3): 273-281.

Svendsen KB, Andersen S, Arnason S, et al.: Breakthrough pain in malignant and non-malignant diseases: A review of prevalence, characteristics and mechanisms. Eur J Pain. 2005; 9(2): 195-206.

Zeppetella G, O’Doherty CA, Collins S: Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manage. 2000; 20: 87-92.

Portenoy RK, Payne D, Jacobsen P: Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999; 81: 129-134.

Højsted J, Nielsen PR, Eriksen J, et al.: Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: A preliminary study. Acta Anaesthesiol Scand. 2006; 50: 1290-1296.

Bruera E, Schoeller T, Wenk R, et al.: A prospective multicenter assessment of the Edmonton staging system for cancer pain. J Pain Symptom Manage. 1995; 10(5): 348-355.

Mercadante S, Maddaloni S, Roccella S, et al.: Predictive factors in advanced cancer pain treated only by analgesics. Pain. 1992; 50: 151-155.

Fortner BV, Okon TA, Portenoy RK: A survey of pain-related hospitalizations, emergency department visits, and physician office visits by cancer patients with and without breakthrough pain. Pain. 2002; 3: 38-44.

Portenoy RK, Bennett DS, Rauck R, et al.: Prevalence and characteristics of breakthrough pain in opioid-treated patients with chronic noncancer pain. J Pain. 2006; 7: 583-591.

Taylor DR, Webster L, Chun SY, et al.: Impact of breakthrough pain on quality of life in patients with chronic, non-cancer pain: Patient perceptions and effect of treatment with oral transmucosal fentanyl citrate (OTFC®, ACTIQ®). Pain Med. 2007; 6: 281-288.

Zeppetella G, O’Doherty CA, Collins S: Prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice. Palliat Med. 2001; 15(3): 243-246.

Cleeland CS, Ryan KM: Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994; 23: 129-138.

Keller S, Bann CM, Dodd SL, et al.: Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004; 20: 309-318.

Disorbio JM, Bruns D: Brief Battery for Health Improvement 2 Manual. Minneapolis, MN: Pearson, 2002.

Cohen J: Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.

Caraceni A, Martini C, Zecca E, et al.: Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med. 2004; 18(3): 177-183.

Bhamb B, Brown D, Hariharan J, et al.: Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006; 22: 1859-1865.

Cleeland CS, Janjan NA, Scott CB, et al.: Cancer pain management by radiotherapists: A survey of radiation therapy oncology group physicians. Int J Radiat Oncol Biol Phys. 2000; 47(1): 203-208.

Potter M, Schafer S, Gonzalez-Mendez E, et al.: Opioids for chronic nonmalignant pain: Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. J Fam Pract. 2001; 50: 145-151.

Morley-Forster PK, Clark AJ, Speechley M, et al.: Attitudes toward opioid use for chronic pain: A Canadian physician survey. Pain Res Manage. 2003; 8(4): 189-194.

Devulder J, Jacobs A, Richarz U, et al.: Impact of opioid rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic nonmalignant pain. Br J Anaesth. 2009; 103: 576-585.



  • There are currently no refbacks.