Remigiusz Lecybyl¹ and Magdi Hanna²

¹Lewisham University Hospital, London, UK. ²Analgesia and Pain Research Hub, Beckeham, UK

Abstract

Breakthrough pain (BTP) management is an unmet clinical need. BTP is poorly diagnosed, rarely evaluated and inadequately reated. BTP is transitory exacerbation of pain experienced by the patient who has relatively stable and adequately controlled baseline pain. BTP is reported to be common in adults and children with cancer as well as in non-cancer diseases associated with acute/chronic pain. Successful management of breakthrough pain depends on adequate assessment, appropriate treatment (cause of pain and symptomatic) and adequate reassessment. Ideal medication for BTP should be characterized with good efficacy and minimal side effects. Pharmacodynamic profile should mimic dynamics of BTP. Strong, short acting analgesics (e.g. opioids) administrated by route which allow quick action had potential to fulfil criteria for ideal ‘rescue’ medication for BTP. Fentanyl Buccal tablets (FBT; Fentora®, Frazer, PA, Cephalon Inc.) is novel delivery system for fentanyl citrate. FBT utilize OraVescent (r) technology to improve bioavability and speed of transmucosal delivery. Alternate routes of administration could further improve efficacy of BTP management. Intranasal and intrapulmonary routes are under exploration. Recently introduced new delivery systems for opioids medication do represent an improvements in BTP management, however BTP is still a major challenge to pain and palliative physicians.