Treating breakthrough pain in oncology

ABSTRACT

Introduction: Breakthrough cancer pain (BTcP) is an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTcP is a heterogeneous condition as episodes vary between individuals. The aim of this article is to review the pharmacologic options for the management of BTcP.

Areas covered: Recent reviews revealed that transmucosal preparations of fentanyl provided superior and more rapid pain relief as compared to placebo and oral morphine within the first 30 min after dosing. Few comparison studies among fentanyl products have been performed. Although dose titration has been recommended for years, a meaningful dosing, according to the level of opioid tolerance, may enhance the advantages of such products

Expert commentary: BTcP represents a relevant problem reported by many cancer patients despite receiving regular use of opioids. Different modalities of pharmacological interventions are available. In comparison with oral opioids, fentanyl preparations appear to have a short onset and offset of analgesic effect, fitting the temporal characteristics of BTcP. Further studies are warranted to assess the net benefit of these drugs to assist decision-making by patients, clinicians, and payers, according to individual clinical conditions.

KEYWORDS:

• Breakthrough pain
• fentanyl preparations
• oral opioids
• cancer pain

Declaration of interest

S Mercadante reports declares work associated with Grunenthal, TEVA, Molteni, Kyowa Kyrin, Takeda and Angelini. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.