Advertisement

Supportive Care in Cancer

, Volume 21, Issue 8, pp 2335–2339 | Cite as

The use of fentanyl buccal tablets for breakthrough pain by using doses proportional to opioid basal regimen in a home care setting

  • Sebastiano Mercadante
  • Giampiero Porzio
  • Federica Aielli
  • Lucilla Averna
  • Corrado Ficorella
  • Alessandra Casuccio
Original Article

Abstract

The dose of rapid onset opioids to be given for breakthrough cancer pain (BTcP) is controversial. Dose proportional to the basal opioid regimen seem to be safe and effective in hospital units. However, data in other less protected settings, like home care, are lacking. The aim of this open-label study was to assess the efficacy and safety in a group of patients with BTcP followed at home, after giving a dose of fentanyl buccal tablets (FBT) proportional to the opioid basal regimen, skipping the steps for dose titration. Consecutive patients admitted to a home care program presenting BTcP episodes and receiving stable doses of opioids for background pain were selected. Data from four consecutive episodes of BTcP were collected. For each episode, patients were instructed to routinely collect changes in pain intensity and severe adverse effects when pain got severe (T0) and to reassess the same items 15 min after FBT, given as a rescue medication in doses proportional to the daily opioid doses used for background pain (T15). One hundred twenty episodes of BTcP were recorded in 30 patients. One hundred eight episodes were defined as successfully treated, while 12 episodes required a further administration of opioids. Pain intensity significantly decreased at T15 (p < 0.001). In 95.5 and 90.8 % of episodes treated, there was a reduction in pain intensity of more than 33 and 50 %, respectively. No relevant adverse effects were recorded, even in older patients. This study suggests that FBT given in doses proportional to the basal opioid regimen for the management of BTcP is very effective and safe in clinical practice in the home care setting.

Keywords

Cancer pain Breakthrough–episodic pain Fentanyl buccal tablet Opioids Home care 

Notes

Acknowledgment

We wish to thank the patients, relatives, and the nursing staff of L' Aquila per la Vita for the support provided in recording the data.

No conflict of interest declared.

No funding

References

  1. 1.
    Aronoff G, Brennan M, Pritchard D, Ginsberg B (2005) Evidence-based oral transmucosal fentanyl citrate (OTFC) dosing guidelines. Pain Med 6:305–314PubMedCrossRefGoogle Scholar
  2. 2.
    Caraceni A, Martini C, Zecca E, Portenoy RK et al (2004) Working group of an IASP task force on cancer pain. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 18:177–183PubMedCrossRefGoogle Scholar
  3. 3.
    Corli O, Pizzuto M (2011) Capire e trattare il brealkthrough cancer pain. Center for the Evaluation and Research on Pain. CIC edizioni internazonali 9-25Google Scholar
  4. 4.
    Davies A, Vriens J, Kennett A, McTeggart (2008) An observational study of oncology patients’ utilization of breakthrough pain medication. J Pain Symptom Manage 35:406–411PubMedCrossRefGoogle Scholar
  5. 5.
    Davies AD, Dickman A, Reid C, Stevens A, Zeppetella G (2009) The management of cancer-related breakthrough pain: recommendations of a task group of the science committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 13:331–338PubMedCrossRefGoogle Scholar
  6. 6.
    Davies A, Zeppetella G, Andersen S et al (2011) Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain 15:756–763PubMedCrossRefGoogle Scholar
  7. 7.
    Hagen NA, Fisher K, Victorino C, Farrar JT (2007) A titration strategy is needed to manage breakthrough cancer pain effectively: observations from data pooled from three clinical trials. J Palliat Med 10:47–55PubMedCrossRefGoogle Scholar
  8. 8.
    Hanks GW, De Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593PubMedCrossRefGoogle Scholar
  9. 9.
    Kleeberg UR, Filbet M, Zeppetella G (2011) Fentanyl buccal tablet for breakthrough cancer pain: why titrate? Pain Pract 11:185–190PubMedCrossRefGoogle Scholar
  10. 10.
    Mercadante S, Arcuri E (1998) Breakthrough pain in cancer patients: pathophysiology and treatment. Cancer Treat Rev 24:425–443PubMedCrossRefGoogle Scholar
  11. 11.
    Mercadante S (2012) Pharmacotherapy for breakthrough cancer pain. Drugs 72(2):181–190PubMedCrossRefGoogle Scholar
  12. 12.
    Mercadante S, Ferrera P, Adile C, Casuccio A (2011) Fentanyl buccal tablets for breakthrough pain in highly tolerant cancer patients: preliminary data on the proportionality between breakthrough pain dose and background dose. J Pain Symptom Manage 42:464–469PubMedCrossRefGoogle Scholar
  13. 13.
    Mercadante S (2011) The use of rapid onset opioids for breakthrough cancer pain: the challenge of its dosing. Crit Rev Oncol Hematol 80:460–465PubMedCrossRefGoogle Scholar
  14. 14.
    Mercadante S, Gatti A, Porzio G, Lo Presti C, Aielli F, Adile C, Casuccio A (2012) Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses. Curr Med Res Opin 28:963–968PubMedCrossRefGoogle Scholar
  15. 15.
    Mercadante S (2009) Breakthrough pain: on the road again. Eur J Pain 13:329–430PubMedCrossRefGoogle Scholar
  16. 16.
    Mercadante S (2010) Intravenous morphine for management of cancer pain. Lancet Oncol 11:484–489PubMedCrossRefGoogle Scholar
  17. 17.
    Mercadante S, Villari P, Ferrera P, Bianchi M, Casuccio A (2004) Safety and effectiveness of intravenous morphine for episodic-breakthrough pain, using a fixed ratio with the oral daily morphine dose. J Pain Symptom Manage 27:352–359PubMedCrossRefGoogle Scholar
  18. 18.
    Mercadante S, Intravaia G, Villari P, Ferrera P, Riina S, Mangione S (2008) Intravenous morphine for episodic-breakthrough pain in an acute palliative care unit: a confirmatory study. J Pain Symptom Manage 35:307–313PubMedCrossRefGoogle Scholar
  19. 19.
    Mercadante S, Villari P, Ferrera P, Casuccio A, Mangione S, Intravaia G (2007) Transmucosal fentanyl vs. intravenous morphine in doses proportional to basal opioid regimen for episodic-breakthrough pain. Br J Cancer 96:1828–1833PubMedCrossRefGoogle Scholar
  20. 20.
    Mercadante S, Villari P, Ferrera P, Mangione S, Casuccio A (2010) The use of opioids for breakthrough pain in an acute palliative care unit by using doses proportional to opioid basal regimen. Clin J Pain 26:306–309PubMedCrossRefGoogle Scholar
  21. 21.
    Mercadante S, Ferrera P, Adile C, Casuccio A (2011) Fentanyl buccal tablets for breakthrough pain in highly tolerant cancer patients: preliminary data on the proportionality between breakthrough pain dose and background dose. J Pain Symptom Manage 42:464–469PubMedCrossRefGoogle Scholar
  22. 22.
    Mercadante S, Villari P, Casuccio A (2011) An Italian survey on the attitudes in treating breakthrough cancer pain in hospice. Support Care Cancer 19:979–983PubMedCrossRefGoogle Scholar
  23. 23.
    Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence, and characteristics. Pain 41:273–281PubMedCrossRefGoogle Scholar
  24. 24.
    Portenoy RK, Payne D, Jacobson P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81:129–134PubMedCrossRefGoogle Scholar
  25. 25.
    Slatkin NE, Xie F, Messina J, Segal TJ (2007) Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. J Support Oncol 5:327–234PubMedGoogle Scholar
  26. 26.
    Zeppetella GB (2008) Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 35:563–567PubMedCrossRefGoogle Scholar
  27. 27.
    Zeppetella G, Messina J, Xie F, Slatkin NE (2010) Consistent and clinically relevant effects with fentanyl buccal tablet in the treatment of patients receiving maintenance opioid therapy and experiencing cancer-related breakthrough pain. Pain Pract 10:287–293PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    • 2
  • Giampiero Porzio
    • 3
  • Federica Aielli
    • 3
  • Lucilla Averna
    • 3
  • Corrado Ficorella
    • 3
  • Alessandra Casuccio
    • 4
  1. 1.Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Department of Anesthesiology, Intensive care and Emergency, Palliative Medicine TeachingUniversity of PalermoPalermoItaly
  3. 3.Department of OncologyUniversity of L’Aquila and L’Aquila per la vita—home careL’AquilaItaly
  4. 4.Department of Experimental Biomedicine and Clinical NeuroscienceUniversity of PalermoPalermoItaly

Personalised recommendations