Fentanyl products in the management of episodic pain in the cancer patient

ABSTRACT Introduction: Breakthrough cancer pain (BTcP) has been defined as a pain exacerbation of short duration in patients who have a well controlled pain for most hours of the day. The principal treatment is represented by administration of a medication as needed. Areas covered: In the last years several short onset delivery systems have been developed. In comparison with oral opioids that often do not fit the typical pattern of a BTcP event, fentanyl products have been shown to produce an analgesic effect within 5–15 min after administration and a duration of about 2 h. These characteristics make these products indicated for BTcP, although concerns have been raised regarding the costs. The choice of the dose is controversial with regulatory studies suggesting the need to titrate the dose, and common clinical sense that suggests to use doses proportional to the basal opioid regimen. Expert commentary: The treatment of BTcP should depend on its characteristics. Pharmacokinetics of oral opioids indicate a late analgesic effect that in most cases is not overlapping the temporal pattern of BTcP, unless in determined circumstances. Dosing of fentanyl products is still matter of controversies.