Fentanyl for Breakthrough Cancer Pain: Where are We?

Fausto      Meriggi; Alberto      Zaniboni

Abstract

Despite relative stable and adequately controlled background pain, Breakthrough Cancer Pain (BTcP) is a transient exarcebation of pain that occurs either spontaneously or in relation to a specific predictable trigger. It is characterized by a typical temporal pattern which includes a short onset (generally a few minutes) and a short duration (30-90 minutes). It has a strong influence on quality of life (QoL), including detrimental effects on activities of daily living, sleep, social relationships and enjoyment of life. Therefore, BTcP represents an important clinical challenge in the care of patients with cancer. Transmucosal fentanyl, a rapid onset opioid (ROO), is indicated for the treatment of BTcP in patients who are already receiving and are tolerant to opioid therapy for underlying, persistent pain. In order to identify published studies on BTcP and ROOs a Medline search was carried out. The characteristics of the various formulations of transmucosal fentanyl used for BTcP and clinical data published in literature will be described in this review.

Keywords: Breakthrough cancer pain, fentanyl, transmucosal delivery, rapid onset opioid, hydromorphon, subcutaneous route, transmucosal, bioavailability, morphine, nasal