title: The "pain pen" for breakthrough cancer pain: a promising treatment.
abstract: Breakthrough pain has been recognized as a challenging pain phenomenon in cancer. Oral transmucosal fentanyl citrate (OTFC) recently has been recommended as treatment, but OTFC is not widely available. Therefore, alternatives are needed. In two separate pilot studies, 58 patients were instructed to self-administer subcutaneous (SC) rescue opioids (hydromorphone (n=43), morphine (n=11), or sufentanil (n=4), using a standard injection-pen for breakthrough pain. Patients were asked to rate the overall efficacy of SC rescue opioids on a 3-point scale (not noticeable, moderate, or good). The efficacy was rated as good in 49 patients (84%, 95% CI: 73-91%), moderate in 8 patients (14%), and not noticeable in 1 patient (2%). The median dose per injection was equianalgesic to 25 mg of SC morphine (range: 4-150 mg). Twenty-nine patients (50%) were treated until death (n=26) or were on ongoing treatment (n=3). Patients were treated for a median of 6 weeks (1 day-41 months).
authors.affiliation: Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Roelien H
authors.initials: RH
authors.lastname: Enting
authors.forename: Carlo
authors.initials: C
authors.lastname: Mucchiano
authors.forename: Wendy H
authors.initials: WH
authors.lastname: Oldenmenger
authors.forename: Magdalena
authors.initials: M
authors.lastname: Fritzon
authors.forename: Anna
authors.initials: A
authors.lastname: Wallen
authors.forename: Simone
authors.initials: S
authors.lastname: Goslinga-van der Gaag
authors.forename: Peter A E
authors.initials: PA
authors.lastname: Sillevis Smitt
authors.forename: Elmar
authors.initials: E
authors.lastname: Delhaas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D010148:Intractable Pain / Q000453:epidemiology* / Q000517:prevention & control*; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012646:Self Administration; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid