title: Use of nasal fentanyl for cancer pain: A pharmacoepidemiological study.
abstract: BACKGROUND
  Breakthrough pain affects 40%-90% of patients with cancer pain. Nasal fentanyl is one of the recommended treatments, particularly if the breakthrough pain is of rapid onset.
  
  
  OBJECTIVE
  To investigate the prevalence of use of nasal fentanyl, to study which strong opioids have been used prior to nasal fentanyl and to examine which opioids are used concomitantly with nasal fentanyl.
  
  
  METHODS
  Longitudinal cohort study based on death cohorts defined according to year of death.
  
  
  METHODS
  The study is based on data from the complete national Norwegian Prescription Database. The study population included all persons in Norway who died in the years 2010, 2011 and 2012 and who had received nasal fentanyl with reimbursement for palliative treatment.
  
  
  RESULTS
  Of those who died from cancer in 2010, 2011 and 2012, 611 persons (2%) received dispensed prescriptions of nasal fentanyl. Two-thirds had received other short-acting strong opioids before nasal fentanyl. One quarter did not receive a long-acting opioid concomitantly with nasal fentanyl, but 68% of these received only one dispensed prescription of nasal fentanyl. Of those who received a long-acting opioid together with nasal fentanyl, transdermal fentanyl was the most common drug (65%). One-third received another short-acting opioid concomitantly with nasal fentanyl.
  
  
  CONCLUSIONS
  The use of nasal fentanyl was surprisingly low. There is a need for clinical research addressing the use of nasal fentanyl without a long-acting opioid for background pain and the use of nasal fentanyl together with another short-acting opioid.
authors.affiliation: Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway olav.m.fredheim@ntnu.no.
authors.forename: Olav Magnus S
authors.initials: OM
authors.lastname: Fredheim
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Milada
authors.initials: M
authors.lastname: Mahic
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Skurtveit
authors.affiliation: Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Petter C
authors.initials: PC
authors.lastname: Borchgrevink
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059390:Breakthrough Pain / Q000188:drug therapy*; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009664:Norway / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods; D017891:Pharmacoepidemiology
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl
keywords: Fentanyl; breakthrough pain; nasal; pharmacoepidemiology