C15 - Visceral Pain: Clinical(697) Attachment style and angina in patients undergoing

myocardial perfusion imagingM. Sullivan, P. Ciechanowski, J. Caldwell, L. Soine, J. Russo, J. Spertus; Univer-sity of Washington, Seattle, WAThe relationship between myocardial ischemia and angina is highly vari-able and poorly understood. Better understanding would help targetappropriate therapy. In accord with an interpersonal model of symptomperception, we hypothesized that daily angina frequency would be re-lated to attachment style. Attachment style is determine by whether oneis considered worthy of care and by whether others are consideredtrustworthy to provide care. 245 patients, age 60.5�11.5, 58% maleunderwent radionuclide myocardial perfusion imaging (64% with exer-cise; 36% with pharmacological stress) to assess for coronary heart dis-ease at the University of Washington Medical Center or the Seattle VAMedical Center. Patients were asked to complete a set of questionnairesprior to their imaging test. Angina over the past 4 weeks was assessedusing the angina frequency scale of the Seattle Angina Questionnaire.Attachment style was assessed by combining scores on the RelationshipScales Questionnaire and the Relationship Questionnaire as: secure(34%), preoccupied (27%), fearful (24%) or dismissing (15%). Rest per-fusion image scores were subtracted from stress image scores to calcu-late a perfusion difference score as the measure of myocardial ischemia.In a linear regression model including age, gender, perfusion differencescore, and continuous measures of the four attachment styles, secureattachment style was associated with significantly less angina (t� 2.1,p�.04). If attachment styles were entered individually (due to collinear-ity), secure (t� 3.1, p�.002) was associated with less and fearful (t��2.6, p�.01) with more angina. If analyzed in terms of main effects,both positive view of self (t�2.1, p�.03) and positive view of others (t�2.0, p�.05) are associated with less angina. Attachment effects remainsignificant if depression (SCL-20) is added to the regression model. Theseresults suggest that interpersonal factors such as attachment style mayhelp determine angina frequency.

C30 - Other(698) Prevalence and characteristics of breakthrough pain in

patients with chronic noncancer painR. Portenoy, D. Bennett, S. Siimon, R. Rauck, D. Taylor, S. Shoemaker; SagemedInc, Boulder, COBreakthrough pain (BTP) has been well characterized in cancer pa-tients1, but has received little attention in patients with chronic noncan-cer pain. We conducted a survey to evaluate the prevalence and charac-teristics of BTP in patients with chronic noncancer pain. Noncancerpatients with controlled baseline pain (* moderate intensity) were iden-tified at the investigator sites and were later surveyed by telephoneabout the characteristics of their pain using a BTP pain assessment algo-rithm originally designed for cancer patients. Seventy-three percent ofpatients surveyed (173/236) reported temporary flares of severe or ex-cruciating pain (i.e., BTP). The most common diagnoses in patients withBTP were back pain (51%), cervical neck pain (9%), and complex re-gional pain syndrome (9%). Primary pain pathophysiologies in thesepatients included somatic pain (36%), visceral pain (5%), neuropathicpain (19%), and mixed pathophysiologies (40%). Twenty patients re-ported more than one type of BTP for a total of 194 different break-through pains and the following data are based on these 194 break-through pains. The median number of episodes per day was 2 (range �1to 12). Median time to maximum intensity was 10 minutes (range 0 to180 minutes) with 46% of the pains reaching maximum intensity within5 minutes. Median duration of the pains was 60 minutes (range 1 to 720minutes). Patients could identify a precipitant for 69% of the pains, and92% of the precipitants were activity related. The onset of BTP couldnever be predicted for 46% of the pains and only sometimes be pre-dicted for 30% of the pains. These results support the conclusions thatBTP is common in patients with chronic noncancer pain, often has arapid onset, has a relatively short duration, and is frequently difficult topredict, thus being similar to BTP in cancer patients. Supported byCephalon, Inc., West Chester, PA.

D. Treatment Approaches (Medical/Interventional)

(699) Withdrawn

D02 - Anticonvulsants(700) Analgesic outcomes in patients with painful diabetic

neuropathy or post-herpetic neuralgia receiving pre-gabalin versus gabapentin

M. Vera-Llonch, E. Dukes, C. Argoff, G. Oster; Policy Analysis, Inc (PAI), Brook-line, MAThis study’s aim was to estimate analgesic outcomes in patients withpainful diabetic peripheral neuropathy (DPN) or post-herpetic neuralgia(PHN) receiving pregabalin versus gabapentin. We developed a stochas-tic simulation model to estimate the impact on analgesic outcomes oftreatment with pregabalin (375 mg/d) versus gabapentin (1200 mg/dand 1800 mg/d) in a hypothetical cohort of 1,000 patients with DPN orPHN. The model was estimated using data from randomized double-blind placebo-controlled flexible-dose clinical trials of these agents, inwhich patients’ pain was evaluated using a 0-10 pain scale; average dailypain intensity at baseline was similar. We used the model to assignexpected daily pain scores over 12 weeks (maximum duration of fol-low-up in pregabalin trial) to each patient, thereby generating “naturalhistories” of untreated pain. Pain scores for treated patients were pro-jected over time using information on the mean ( SD) weekly percentchange in pain scores from the trials. Outcomes of interest included themean number of days with no or mild pain (score �3), and days with�30% and �50% reductions in pain intensity. Compared with no treat-ment, pregabalin (375 mg/d) yielded an estimated 37 ( 0.3) (mean[ SE]) additional days with no or mild pain, 50 ( 0.3) days with �30%reduction in pain intensity, and 37 ( 0.4) days with �50% reduction inpain intensity. Comparable figures for gabapentin 1200 mg/d were 25( 0.2), 41 ( 0.3), and 23 ( 0.3); for gabapentin 1800 mg/d, they were 26( 0.3), 42 ( 0.4), and 26 ( 0.4). In patients with DPN or PHN, pregabalinmay provide better analgesic outcomes than gabapentin over a 12-weekperiod.

S33Abstracts