Quick Relief for Breakthrough Pain

CURE, Spring 2006, Volume 5, Issue 1

Occurring in up to 86 percent of chronic pain patients, breakthrough pain can be relieved by medication that acts within minutes for a short time.

Many patients with chronic pain experience short bursts of severe pain that “break through” their long-acting pain medication. Although the pain can occur with certain activities or sudden movements, it can also appear without cause and last up to an hour. Occurring in up to 86 percent of chronic pain patients, breakthrough pain can be relieved by medication that acts within minutes for a short time.

Only an oral fentanyl called Actiq has been approved specifically for cancer-related breakthrough pain. Shaped liked a swab so patients can easily wipe it on the inside of the mouth for fast delivery, the fentanyl begins to relieve pain in five to 15 minutes. While 25 percent of the drug enters the bloodstream through the cheek lining to relieve pain almost immediately, the remainder is swallowed, which provides longer relief for several hours. A sugar-free version was approved in 2005.

Because many cancer patients with chronic pain use Actiq for several years, a study looked at the long-term effects of the drug. More than 400 cancer patients who used Actiq at least once a day were studied for over a year. The study showed over 90 percent of patients reported pain relief and no long-term effects were found with the painkiller. Short-term side effects can include nausea, dizziness and fatigue.

An injectable opioid is being researched for breakthrough pain in cancer patients. An early-phase study compared oral immediate-release morphine with hydromorphone injected through a “pain pen” and found that the injection offers effective and more immediate relief than oral medication. A phase III study is currently enrolling patients.

Taifun, a fentanyl that is inhaled as a powder, may also provide fast relief for breakthrough pain. A phase II trial was initiated after an early study showed Taifun was safe and provided pain relief within minutes. Fentanyl that is inhaled or absorbed through the lining of the mouth, like Actiq, may be easier for patients to take if they have complications with swallowing or injections.