A comprehensive review of rapid-onset opioids for breakthrough pain.
Breakthrough pain (BTP) is a transitory pain (reaching maximum severity in ~15 minutes and lasting ~60 minutes in patients with cancer) that occurs despite the management of chronic pain with long-term around-the-clock analgesia. BTP occurs in 33-65% of patients with chronic cancer pain and in ~70% of patients with chronic noncancer pain. BTP has historically been managed with short-acting opioids; however, these medications have a pharmacokinetic profile that does not correlate with the sudden onset and short time to maximum severity of BTP. Interest in rapid-onset opioids to relieve BTP has therefore been growing. This comprehensive review aims to summarize the currently available clinical data for the approved rapid-onset opioids, which comprise different formulations of fentanyl, a μ-opioid receptor agonist with anaesthetic and analgesic properties. Administration routes for fentanyl in the management of BTP currently include the transmucosal and intranasal routes; an intrapulmonary formulation is also in development. The findings of this review suggest that the efficacy and safety of the approved rapid-onset opioids are comparable.
Departments of Anesthesiology, Medicine, and Physical Medicine & Rehabilitation, Albany Medical College, Albany, NY 12208, USA. SmithH@mail.amc.edu
Howard
H
Smith
D059390:Breakthrough Pain / Q000188:drug therapy*; D059350:Chronic Pain / Q000188:drug therapy; D004333:Drug Administration Routes; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000523:psychology
D005283:Fentanyl