title: Fentanyl pectin nasal spray as treatment for incident predictable breakthrough pain (BTP) in oral mucositis induced by chemoradiotherapy in head and neck cancer.
abstract: BACKGROUND
  Painful mucositis is one of the most distressing toxicities of chemoradiotherapy (CRT) for head and neck cancer (HNC), with the characteristics of incidental predictable breakthrough pain (BTP) during swallowing. Fentanyl pectin nasal spray (FPNS) could be a good therapeutic option.
  
  
  METHODS
  Patients were prospectively considered if receiving basal analgesic therapy with opiates for painful mucositis of grade ⩾4 on a numerical rating scale from 0 to 10. They were offered FPNS 100mcg before oral intake. When patients reached the effective dose, they evaluated the basal pain intensity before FPNS use and after 10, 20, 30 and 40min.
  
  
  RESULTS
  Seventeen HNC patients were offered FPNS before oral intake, with 15 patients completing treatment. Mean reduction of incidental BTP intensity after FPNS was 3.1 points (range 1.2-5.8). Mean time elapsed since FPNS use and highest pain reduction was 26min.
  
  
  CONCLUSIONS
  FPNS demonstrated activity against BTP when swallowing in HNC patients. These data should be considered as hypothesis-generating.
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Locati
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Bergamini
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Mirabile
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Granata
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Imbimbo
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Resteghini
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Licitra
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000188:drug therapy* / Q000209:etiology; D003131:Combined Modality Therapy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010368:Pectins / Q000008:administration & dosage; D013280:Stomatitis / Q000150:complications / Q000209:etiology*
chemical_list: D000701:Analgesics, Opioid; D010368:Pectins; D005283:Fentanyl
keywords: Breakthrough pain (BTP); Chemo radiotherapy; Fentanyl pectin nasal spray; Head and neck cancer; Oral mucositis