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Introduction: Cancer pain can appear with spikes of higher intensity. Breakthrough cancer pain (BTCP) is the most common term for the transient exacerbations of pain, however despite the large amount of studies, controversies exist about the definition, epidemiology and best pharmacological treatment option for BTCP. Aim: This article reviews generally accepted concepts for the correct recognition, assessment and management of BTCP as well as results of recent studies and trials in this topic. Methods: A systematic review of the literature focused on defining, categorization, assessment and treatment of BTCP within Pubmed, MedLine, and Embase electronic databases was performed, setting up the date to 28th February 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: The most appropriate therapeutic choice for BTCP appears to be a rapid-onset opioid (ROO). Fentanyl products provide superior efficacy and rapidity of action as compared to placebo and oral morphine. Few comparison studies among fentanyl products have been conducted. The choice of fentanyl products should be based on individual clinical conditions. Dose of BTCP rescue drug should be titrated, however initial titration dose should be guided by tolerance to opioids given for background analgesia. Algorithms to diagnose BTCP should be used followed by a careful and comprehensive clinical assessment Conclusion: Future research should focus on creating worldwide compromise on definition and classification systems of BTCP to allow particular investigation of the epidemiology and optimal management of BTCP. [ABSTRACT FROM AUTHOR]

Background: Breakthrough cancer pain (BTCP) is complex and severe, affecting quality of life and increasing hospitalisation. BTCP has a rapid onset that requires fast acting medication with minimal side effects. Aim: This article compares the effectiveness of intranasal fentanyl spray (INFS) and oral transmucosal fentanyl citrate (OTFC) and their alleviation of BTCP within 10 minutes of administration. Method: The article considers pharmacokinetic and bioavailability studies demonstrating the efficacy of the route of administration, time-based effects of pain relief as well as patient preference. Conclusion: The data collected indicates that INFS is more effective than OTFC for BTCP. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to explore the efficacy of intranasal fentanyl spray* (INFS) 400 μg to evaluate 12-week tolerability of the nasal mucosa and to explore safety data for all dose strengths of INFS in patients with cancer-related breakthrough pain (BTP). Methods: Patients received a test dose of INFS 50 μg, followed by a titration phase. Those patients with doses titrated to 200 or 400 μg entered a randomized, double-blind, cross-over efficacy phase, in which 8 episodes of BTP were randomly treated with INFS 400 μg (6 episodes) and placebo (2 episodes), followed by a tolerability phase. Patients with doses titrated to 50 or 100 μg entered the tolerability phase directly. Primary outcome was measured by pain intensity difference at 10 minutes, analyzed using ANCOVA, and presented as least square mean difference. Examination of the nasal cavity was conducted at inclusion and after 12 weeks of treatment by an otorhinolaryngologist. Findings: Forty-six patients were included. Thirty-eight patients' doses were titrated to an effective dose of INFS; 50 μg (n = 8), 100 μg (n = 9), 200 μg (n = 9), and 400 μg (n = 12); 15 patients entered the efficacy phase and 31 entered the tolerability phase. In the efficacy phase, 88 and 29 episodes of BTP were treated with INFS 400 μg and placebo, respectively. Pain intensity difference at 10 minutes least square mean for INFS 400 μg was 2.5 (95% CI, 1.42_3.49) (P < 0.001) and least square mean difference between INFS 400 μg and placebo was 1.1 (95% CI, 0.41-1.79) (P = 0.002). Runny nose (10%) and change in color of the mucosa (9%) were the most frequent findings of nasal examination, and nausea and dizziness were the most frequent treatment-related adverse events. One serious adverse event (ie, respiratory depression) was considered related to INFS. Implications: INFS 400 μg is effective and nasal tolerability and overall safety profile is acceptable during 12 weeks of use. [ABSTRACT FROM AUTHOR]