Recent and Upcoming Approaches in the Management of Cancer Breakthrough Pain

The pharmacokinetics of the traditional oral opioids do not match the time course of breakthrough cancer pain, a common and distinct component of cancer pain which has a negative impact on quality of life for the patient.Fentanyl and alfentanil are potent, lipophilic, fast acting opioids with short durations of action and consequently more appropriate for the treatment of breakthrough cancer pain. These agents are ideal for oral transmucosal or nasal transmucosal administration.There are now four licensed preparations of fentanyl in the UK for the treatment of cancer breakthrough pain; lozenge, buccal tablet, sublingual tablet and nasal spray. They are not interchangeable and all require titration using the lowest dose.Alfentanil is available as a buccal or nasal spray. It is an unlicensed product and is available as a special order from Torbay Pharmacy Manufacturing Unit.There is a paucity of comparator studies for these new modes of administration.Further innovative delivery systems of fentanyl are on the horizon.