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Development of Recombinant Proteins to Treat Chronic Pain
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Treating breakthrough pain in oncology.

Sebastiano Mercadante1

  • 1a Anesthesia and Intensive Care &Pain Relief and Palliative Care Unit , La Maddalena Cancer Center , Palermo , Italy.

Expert Review of Anticancer Therapy
|February 27, 2018
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Breakthrough cancer pain (BTcP) management is reviewed, finding transmucosal fentanyl superior to placebo and oral morphine for rapid relief. Optimal dosing based on opioid tolerance may further enhance fentanyl

Keywords:
Breakthrough paincancer painfentanyl preparationsoral opioids

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Area of Science:

  • Oncology
  • Pain Management
  • Pharmacology

Background:

  • Breakthrough cancer pain (BTcP) significantly impacts patients despite adequate opioid therapy.
  • BTcP episodes are heterogeneous and vary significantly among individuals.

Purpose of the Study:

  • To review pharmacologic options for managing breakthrough cancer pain (BTcP).

Main Methods:

  • Literature review of recent studies on BTcP pharmacologic interventions.
  • Analysis of comparative studies on fentanyl preparations versus placebo and oral morphine.

Main Results:

  • Transmucosal fentanyl preparations offer superior and faster pain relief within 30 minutes compared to placebo and oral morphine.
  • Few direct comparisons exist between different fentanyl products.
  • Dose titration tailored to opioid tolerance can optimize fentanyl's benefits.

Conclusions:

  • Fentanyl preparations provide rapid onset and offset of analgesia, aligning with BTcP's temporal profile.
  • Further research is needed to establish the net benefit of these agents for informed clinical and payer decisions.