Efficacy of Sublingual Fentanyl vs. Oral Morphine for Cancer-Related Breakthrough Pain

Rivera, Ignacio Velázquez; Garrido, José Carlos Muñoz; Velasco, Pilar García; Enciso, Inmaculada España Ximénez de; Clavarana, Lourdes Velázquez

doi:10.1007/s12325-013-0086-4

Cited by 23 publications

(11 citation statements)

References 31 publications

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“…A similar amount of pain reduction following treatment was observed in several intervention studies on CBTP 14,15…”

Section: Discussionsupporting

confidence: 75%

“…The study monitored for changes in LF and log LF/HF in patients with opioid treatment for CBTP, which is an abrupt, short-lived, and intense pain that “breaks through” the sustained-released analgesia provided to control persistent pain13 and responds to treatment with opioids within minutes 14,15. Pain was assessed using an NRS with a range from 0 to 10 on which 0 was defined as “no pain” and 10 was defined as “worst pain imaginable”.…”

Section: Methodsmentioning

confidence: 99%

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Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Masel

Huber

Engler

et al. 2016

JPR

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BackgroundDecisions on the intensity of analgesic therapy and judgments regarding its efficacy are difficult at the end of life, when many patients are not fully conscious and pain is a very common symptom. In healthy individuals and in postoperative settings, nociception and subsequent pain relief have been shown to induce changes in the autonomic nervous system (ANS), which can be detected by measuring heart rate variability (HRV).ObjectivesThe changes in the ANS were studied by measuring HRV during opioid therapy for cancer breakthrough pain (CBTP) in palliative-care patients with cancer and compared these changes with patient-reported pain levels on a numeric rating scale (NRS).Patients and methodsThe study included ten patients with advanced cancer and baseline opioid therapy. In each patient, a 24-hour peak-to-peak HRV measurement with a sampling rate of 4,000 Hz was performed. High frequency (HF), low frequency (LF), total power, pNN50 (indicating parasympathetic activity), and log LF/HF were obtained in two intervals prior to therapy and in four intervals thereafter. Intensity of CBTP was recorded using a patient-reported NRS prior to therapy and 30 minutes afterward.ResultsCBTP occurred in seven patients (three males and four females; mean age: 62 ± 5.2 years) and was treated with opioids. A highly significant positive correlation was found between opioid-induced reduction in patient-reported pain intensity based on NRS and changes in log LF/HF (r > 0.700; p < 0.05). Log LF/HF decreased in patients who had a reduction in pain of >2 points on the NRS but remained unchanged in the other patients.ConclusionOur data suggest that log LF/HF may be a useful surrogate marker for alleviation of CBTP in patients with advanced cancer and might allow detection of pain without active contribution from patients.

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“…A similar amount of pain reduction following treatment was observed in several intervention studies on CBTP 14,15…”

Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Masel

Huber

Engler

et al. 2016

JPR

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“…One prospective, longitudinal study compared the orally disintegrating sublingual tablet with oral immediate release morphine. 63 Details of the study are presented in tables 5 – 8 . Patients with breakthrough cancer pain were randomised to start with either the sublingual tablet or with morphine for 30 days and were then titrated to an effective dose of both drugs.…”

Section: Clinical Efficacymentioning

confidence: 99%

“…At days 7, 15 and 30 statistical significance was reached as early as 5 min and showed significantly faster time to onset of relief for the sublingual tablet over the oral morphine at all stages (p<0.001). 63 …”

Section: Clinical Efficacymentioning

confidence: 99%

Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis

et al. 2017

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Drug selection of rapid acting fentanyl formulations in the treatment of breakthrough pain in patients with cancer is performed by the System of Objectified Judgement Analysis method. All seven available formulations were included in the analysis. The following selection criteria were used: number of available strengths, variability in the rate of absorption, interactions, clinical efficacy, side effects, ease of administration and documentation. No direct double-blind comparative studies between two or more formulations were identified and the clinical documentation of all formulations is limited. The most distinguishing criterion was ease of use. This led to slightly higher scores for Abstral, Instanyl and PecFent than for the other formulations. The pros and cons of each formulation should be discussed with the patient, and the most suitable formulation selected for each individual patient.

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“…Most cancer pain is chronic and caused by the tumor. About 50–90% of patients reported intermittent flaring of pain [4] with a 30–40% rate during the early stages of the disease and 70–90% during advanced stages [5]. …”

Section: Introductionmentioning

confidence: 99%

A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial

Liu

Wang

Luo

et al. 2017

Trials

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BackgroundThe management of breakthrough pain in cancer patients is always a challenge for medical professions. Occurring in 80% of cancer patients with advanced disease, breakthrough pain significantly decreases both patient’s and caregiver’s quality of life. The aim of this study is to assess the analgesic efficacy of a fixed inhaled nitrous oxide/oxygen mixture for adult cancer patients with breakthrough pain.Methods/designThis is a randomized, placebo-controlled, double-blind study; it will be conducted in the General Hospital of Ningxia Medical University. The target study subjects are at least 18 years old, and are hospitalized cancer patients who are receiving routine opioids to control cancer-related pain but still experience breakthrough pain. A total of 240 patients will be recruited and randomly allocated between three treatment groups (A, B, C) and a control group (group D) in a ratio of 3:1. All treatment groups (A, B, C) will receive standard pain treatment (oral immediate-release morphine) plus a pre-prepared nitrous oxide/oxygen mixture, and the control group (D) will receive the standard pain treatment plus oxygen. Patients, doctors, nurses, and data collectors are all blind to the experiment. Assessments will be taken before treatment (T0), at 5 min (T1) and 15 min (T2) during treatment, and at 5 min after treatment (T3). The primary endpoint measures will be the percentage of patients whose pain is relieved at T1, T2, and T3. Secondary outcome measures will include the safety of treatment, adverse events, and satisfaction from both health professionals and patients.DiscussionThis study aims to provide an effective and practical intervention for a fast breakthrough pain relief and to improve cancer patients’ quality of life significantly. The Evidence-Based Medicine Working Group claim that a randomized, double-blind, placebo-controlled experimental intervention is the most appropriate design to demonstrate its efficacy, so this study could give a new approach to controlling breakthrough pain episodes.Trial registration ChiCTR-INC-16008075. Registered on 8 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1739-9) contains supplementary material, which is available to authorized users.

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Efficacy of Sublingual Fentanyl vs. Oral Morphine for Cancer-Related Breakthrough Pain

Abstract: Administration of SLF might provide a more effective treatment option than oral morphine for BTcP.

Cited by 23 publications

References 31 publications

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis

A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial

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