Alvarez, NA

Gould, EM

Victor, TW

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participants missed a total of 191 work hours due to BTP
(mean = 1.9 work hours lost per participant). Many were unable
to work due to disability (n = 45; 31.7%) and disability was
more common in patients with 2 or more painful conditions
(p = 0.004). Anxiety and depression were noted to be prevalent
(22.5% reported anxiety, 24.6% reported depression, 16.2%
reported both), particularly among those with headache alone or
2 or more painful conditions (p = 0.035). CONCLUSION:
Patients with BTP frequently seek care to control their pain and
also experience productivity loss. Anxiety and depression may
add to the economic burden of BTP.
PAIN—Health Care Use & Policy Studies
PPN8
CHRONIC PAINTREATMENT WITH OPIOIDS: PRACTICE DOES
NOT FOLLOW POLICY
Victor TW,Alvarez NA, Gould EM
Endo Pharmaceuticals Inc, Chadds Ford, PA, USA
OBJECTIVES: To examine the use of extended release (ER)
opioids relative to immediate release (IR) opioids in chronic
opioid treatment episodes. METHODS: Data from the i3
Innovus Lab/Rx Database were used in this analysis. Enrollees
having at least one pharmacy claim for a combination opioid,
extended release opioid or immediate release opioid between
June-2003 and May-2006 and having at least one year of con-
tinuous enrollment beyond the date of their ﬁrst observed opioid
pharmacy claim were included in this analysis. Opioid-related
treatment episodes were created by combining contiguous days
of therapy allowing for a maximum of a 7-day gap between
medication reﬁlls. Opioid-containing preparations were classiﬁed
as either ER or IR formulations. Outcomes are reported in the
form of probabilities and odds-ratios. RESULTS: A total of
3,993,011 opioid treatment episodes were derived from
1,967,898 patients. Overall, treatment episodes involving IR
preparations (97.7%) are more prevalent than treatment epi-
sodes using ER preparations (2.3%). The odds of an ER pre-
paration being prescribed chronically (> = 60 days) was
approximately 11 times that of an IR preparation, OR = 10.7.
The data were further stratiﬁed by prescriber-type (designated as
pain specialist or non-specialist). The probability of a pain spe-
cialist prescribing ER opioids in these chronic episodes was
19.1%; whereas the probability for non-specialists was 13.7%.
In comparing the two prescriber groups, pain specialists are
about 50% more likely to prescribe ER opioids relative to non-
specialists, OR = 1.49. CONCLUSION: These data suggest that
clinical practice does not follow accepted pain treatment guide-
lines for chronic pain. Further research will need to be conducted
to better understand physician prescribing behaviors as they
relate to chronic pain treatment and why the existence of treat-
ment guidelines may not alone be sufﬁcient to promote a medi-
cation regimen that will optimize pain care for appropriate
patients.
PAIN—Methods and Concepts
PPN9
PERCEPTION OF BREAKTHROUGH PAIN IN PATIENTS WITH
CHRONIC PAINFUL CONDITIONS
Pizzi LT1, Lee SP1, Richardson D1, Cobb N2, Leas B2,Toner R2,
Pracilio V2, Ballas S2,Ashkenazi A2, Derk CT2,Wang D2, DeSousa E2
1Jefferson Medical College, Philadelphia, PA, USA, 2The Breakthrough
Pain Study Group, Philadelphia, PA, USA
OBJECTIVES: To understand how patients with chronic non-
cancer pain deﬁne and describe breakthrough pain (BTP).
METHODS: This prospective study included outpatients from a
large U.S. tertiary medical center who suffer from chronic pain
due to headache, arthritis/rheumatism, musculoskeletal prob-
lems, or sickle cell anemia. Data were collected using a 1-week
pain diary with questionnaire that captured their perceptions of
BTP. Participants were asked to choose a term that best describes
a pain ﬂare and a deﬁnition of the term they selected. Pain scores
were captured using a 10-point visual analog scale (VAS).
RESULTS: The study cohort included 161 patients (36 with
headache, 19 with arthritis/rheumatism, 17 with sickle cell
anemia, 8 with musculoskeletal problems, and 70 with 2 pain
conditions). Most were female (80.1%), white (67.7%), and
experienced BTP during the diary week (90.5%). The mean pain
level reported during the diary week was 6, and the mean age was
49.3 years. The terms used to describe BTP were “pain ﬂare”
(34%), “acute pain episode” (29.1%), “pain crisis” (19.9%),
“sudden new pain episode” (16.5%), and “breakthrough pain”
(11.9%). There were no differences by pain source except among
headache patients, where more than half (52.8%) termed BTP as
“an acute pain episode.” Most commonly selected deﬁnitions for
BTP were “sudden pain more than your chronic pain” (31.3%),
“a period of pain worse than your controlled pain” (26%) and
“a brief episode of pain more intense than your usual pain”
(21.3%). There were no differences in preferred BTP deﬁnition
by pain source. CONCLUSION: Patients with chronic pain
prefer to use the terms “pain ﬂare” and “acute pain episode”
rather than “breakthrough pain” when referring to BTP. The
concepts of “brief” and “sudden” appear to be important when
deﬁning BTP. Results will be helpful to outcomes researchers
who study pain.
PPN10
LINGUISTIC ADAPTATION INTO SPANISH AND
PSYCHOMETRICVALIDATION OFTHE NEUROPATHIC PAIN
SCREENING QUESTIONNAIRE: ID PAIN
Gálvez R1, Pardo A2, Cerón JM3,Villasante F4,Aranguren JL5,
Saldaña MT6, Navarro A7, Ruiz MA2, Díaz S8, Rejas J9
1University Hospital “Virgen de las Nieves”, Granada, Spain,
2Universidad Autónoma de Madrid, Madrid, Spain, 3Primary Care
Centre “San Antonio”, Motril, Granada, Spain, 4Primary Care Centre
“José Marvá”, Madrid, Spain, 5Clínica MADRID, Fuenlabrada, Madrid,
Spain, 6Primary Care Centre “Raíces”, Castrillón, Asturias, Spain,
7Primary Care Centre “Puerta del Ángel”, Madrid, Spain, 8Euroclin
Institute, Madrid, Spain, 9Pﬁzer Spain, Madrid, Spain
OBJECTIVES: To achieve a linguistic adaptation and psycho-
metric validation into Spanish of the ID Pain questionnaire for
the screening of differential diagnosis of pain with a neuropathic
component. METHODS: Cross-sectional validation study
carried out in two phases: cultural adaptation into Spanish lan-
guage and validation study to test psychometric properties of the
scale in men and women >18 years, with neuropathic (NP) and
noniceptive (NNP) chronic pain for more than 6 months. Scale
properties of feasibility, reliability and validity were evaluated
according to clinical and LANNS scale reference diagnosis.
Factor and ROC curves analysis, agreement with reference diag-
nosis and determination of sensitivity and speciﬁcity values were
assessed. RESULTS: A total of 283 subjects (64.4% women;
mean age: 59.1 + 14.9 years), 145 (51.2%) with NP and 138
(48.8%) with NNP were included in the study. Time to comple-
tion of questionnaire was 4.2 (3.0) minutes, and 15% of patients
needed some help to complete it only. Factor analysis showed a
one-dimension scale only, explaining the 37.5% of total variance.
The instrument was time-stable (test-retest r-Pearson = 0.98,
p < 0.0005). Mean score differentiated NP from NNP patients;
3.5 (1.2) vs. 1.2 (1.4); p < 0.0005. Optimum cut-off value was >3
A466 Abstracts


PPN8 CHRONIC PAIN TREATMENT WITH OPIOIDS: PRACTICE DOES NOT FOLLOW POLICY 

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PPN8 CHRONIC PAIN TREATMENT WITH OPIOIDS: PRACTICE DOES NOT FOLLOW POLICY

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