title: The management of wound-related procedural pain (volitional incident pain) in advanced illness.
abstract: OBJECTIVE
  The prevention and treatment of wound-related procedural pain is one of the greatest areas of unmet need within wound management. Also referred to as 'Volitional Incident Pain', it is the most prevalent subtype of breakthrough pain experienced by patients afflicted with wounds. Novel formulations of existing analgesics are now available to address this challenge.
  
  
  RESULTS
  This review focuses on the principles of breakthrough pain assessment including those patients with cognitive impairment. Current management principles are discussed with an emphasis on the novel formulations of fentanyl citrate that may be delivered through the sublingual, buccal, and nasal mucosal routes.
  
  
  CONCLUSIONS
  Novel formulations of fentanyl citrate, delivered through an array of noninvasive routes, allow for rapid-onset and short-acting effects that better match the onset and duration of wound-related procedural pain.
authors.affiliation: Department of Family and Community Medicine, Divisions of Palliative and Residential Care, Providence Healthcare, Vancouver, Canada. rgallagher@providencehealth.bc.ca
authors.forename: Romayne
authors.initials: R
authors.lastname: Gallagher
mesh_terms: D000278:Administration, Buccal; D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003072:Cognition Disorders / Q000150:complications; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D009779:Occlusive Dressings / Q000009:adverse effects / Q000592:standards; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D019452:Terminally Ill; D014947:Wounds and Injuries / Q000150:complications / Q000209:etiology / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl