Evaluation of the effectiveness of oral transmucosal fentanyl in the treatment of breakthrough pain in cancer patients

Background. In cancer patients persistent pain can co-exist with acute, severe pain, so called breakthrough pain. This kind of pain is relatively common, and difficult to treat. Breakthrough pain is usually managed with supplemental strong and short-acting analgesic medications. The objective of this work was to evaluate effectiveness of oral transmucosal fentanyl citrate for the management of the breakthrough pain. Materials and methods. 26 adult patients of Hospice of Bialystok with persistent cancer pain were recruited into this study. Patients received transdermal fentanyl for persistent pain and oral morphine or transmucosal fentanyl for breakthrough pain. Chronic and breakthrough pain intensity, time to pain relief and patients’ satisfaction scores were recorded. Results. The median of chronic pain intensity was 2.1 and median of breakthrough pain was 6 according to visual analogue scale (VAS). There was no difference between oral morphine and submucosal fentanyl in pain relief, but time to pain relief was significantly shorter in case of fentanyl. Plasma fentanyl concentrations ranged between 0.39 and 1.86 ng/ml and did not increase after transmucosal administration of fentanyl. Conclusions. Transmucosal fentanyl appears effective in the management of breakthrough pain. Cancer patients found this therapy acceptable.