British Journal of Cancer · 2007 · 108 citations · 16 references
FentanylPain MedicineOpioid RegimenEpisodic-breakthrough PainPharmacotherapyIntravenous MorphineAddiction MedicinePain ManagementAnalgesicsHealth SciencesOtfc DosesOtfc DosingMedicinePostoperative Pain ManagementNeuropharmacologyPharmacologyPain ResearchAddictionCancer PainOpioid OverdoseAnesthesiaOncologyOpioid Use DisorderAnesthesiology
Supplemental opioid doses are commonly used to manage breakthrough pain. The study proposes future comparative research to evaluate titration versus proportional dosing of oral transmucosal fentanyl citrate. The authors conducted a comparative study in 25 cancer patients, administering intravenous morphine and oral transmucosal fentanyl citrate in doses proportional to each patient’s basal opioid regimen, and recorded pain intensity and opioid‑related symptoms at baseline, 15, and 30 minutes post‑treatment across 53 breakthrough events. Intravenous morphine reduced pain more rapidly than oral transmucosal fentanyl citrate, showing significant superiority at 15 minutes but not at 30 minutes, while both treatments were similarly safe and effective.
The use of supplemental doses of opioids is commonly suggested to manage breakthrough pain. A comparative study of intravenous morphine (IV-MO) and oral transmucosal fentanyl citrate (OTFC) given in doses proportional to the basal opioid regimen was performed in 25 cancer patients receiving stable opioid doses. For each episode, when it occurred and 15 and 30 min after the treatment, pain intensity and opioid-related symptoms were recorded. Fifty-three couples of breakthrough events, each treated with IV-MO and OTFC, were recorded. In episodes treated with IV-MO, pain intensity decreased from a mean of 6.9 to 3.3 and to 1.7 at T1 and T2, respectively. In episodes treated with OTFC, pain intensity decreased from a mean of 6.9 to 4.1 and to 2.4 at T1 and T2, respectively. Statistical differences between the two treatments were found at T1 (P=0.013), but not at T2 (P=0.059). Adverse effects were comparable and were not significantly related with the IV-MO and OTFC doses. Intravenous morphine and OTFC in doses proportional to the scheduled daily dose of opioids were both safe and effective, IV-MO having a shorter onset than OTFC. Future comparative studies with appropriate design should compare titration methods and proportional methods of OTFC dosing.
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Morphine and alternative opioids in cancer pain: the EAPC recommendations
G.W. Hanks, Franco De Conno, Nathan I. Cherny et al. · British Journal of Cancer · 2001 · 847 citations · Full text