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Opioids for the management of breakthrough pain in cancer patients

Zeppetella G, Davies AN
Published Online: 
21 October 2013

Background

Oral and nasal transmucosal fentanyl citrate are effective in the management of breakthrough pain. Breakthrough pain is an additional sudden brief pain that occurs despite taking regularly scheduled doses of pain medication. It is a common and debilitating component of pain in patients with cancer.

Study characteristics

We sought clinical trial evidence to determine the effectiveness of opioids in relieving breakthrough pain and the incidence of side effects in cancer patients. The evidence is current to 6 February 2013.

We identified 15 trials and included 1699 participants. The identified studies examined the use of oral and nasal transmucosal fentanyl citrate (an opioid medicine that relieves pain administered across the mucous membrane of either the mouth or nose) in breakthrough pain in cancer patients taking regularly scheduled opioids. Most studies measured similar outcomes.

Key results

Available data suggest that both oral and nasal transmucosal fentanyl citrate are safe and effective (compared with both placebo and morphine) in relieving breakthrough pain. The side effect profiles of oral and nasal transmucosal fentanyl citrate were similar to other opioids. Recommendations are made about future clinical trials.

Quality of the evidence

We could wish for more consistency in study design and more studies comparing the oral and nasal transmucosal fentanyl citrate formulations to one another.