BUDAPEST, Hungary, June, 7, 2007--A pioneering nasal spray
could stop thousands of patients with cancer from suffering
unnecessary pain; it was reported today1 at the 10th Congress of
the European Association for Palliative Care, Budapest, 7–9
June. The study investigated whether this first in class novel
formulation could provide fast onset of pain relief and short
duration of effect, mirroring the breakthrough pain often
experienced by patients with cancer.
The majority of patients with cancer experience chronic pain during the course of their illness.2 However, patients with cancer can experience breakthrough pain despite adequate chronic background pain treatment.3 Breakthrough pain comes on very quickly, lasts for about 30 minutes on average, and can be very intense.2–4 The ideal treatment should mimic the typical breakthrough pain episode and provide tight control of the pain, i.e. fast but short-acting pain relief.
The trial comparing intranasally with intravenously administered fentanyl showed that pain relief in all patients was 6–8 minutes after intranasal administration.1 The duration of pain relief provided by both routes was essentially the same.1 The bioavailability of the intranasal administered fentanyl was 89%.1
Dr Lona Christrup of the University of Copenhagen, Denmark, explained ‘As a model for patients with cancer, we tested intranasal fentanyl to treat patients suffering pain after dental surgery.’ Dr Christrup also stated that ‘The intranasal fentanyl spray used in our study provided tight control of the pain meaning fast onset of action and relatively short duration of effect, making it a promising method for treating breakthrough cancer pain. This method of administration has the added advantage of being very easy to use, which is especially important for patients with cancer.’
These findings were discussed in the ‘Challenges in treating breakthrough pain’ satellite symposium, which examined the problems in treating and managing this debilitating condition. Breakthrough pain is a complex condition needing individualised patient management,5 and is a very widespread problem among patients with cancer.6 A drug with fast onset, short duration of action and ease of use was deemed to be the ideal treatment. Currently, oral morphine is the most frequently used treatment for breakthrough pain. However, oral morphine is far from ideal for patients with breakthrough cancer pain for two reasons. It takes about 30 minutes to have an effect, missing the majority of the breakthrough pain episode, and lasts for 4–6 hours, far longer than the breakthrough pain episode.
Commenting on the trial findings, Dr Andrew Davies, Consultant in Palliative Care, Royal Marsden Hospital said: ‘The results of this trial are particularly interesting in terms of the potential use of intranasal fentanyl to relieve breakthrough pain in patients with cancer. This is a unique type of pain, and so needs a unique form of treatment. Our research has shown that most patients are prescribed strong oral opioid analgesics, despite the fact that these are not the best choice of treatment. Greater attention needs to be given to the problem of breakthrough pain, and healthcare professionals need to be made aware of the general principles of management, and particularly the pros and cons of different forms of strong opioid analgesics.’
NOTES FOR EDITORS
A background document focusing on breakthrough cancer pain is available on request.
For more information about breakthrough pain please visit the breakthrough pain resource www.breakthroughpain.eu where also full details of all presentations from the ‘Challenges in treating breakthrough pain’ satellite symposium can be found.
For further information
Dr Susan Craib, Wells Healthcare
Phone: +44 1892 511600
Mobile: +44 7703 544 957
Susanne Hof, Nycomed, Head of External Communications
Phone: +49 7531 84 30 59
Mobile: +49 151 55 00 26 65
1. Popper L, Christrup L. Breakthrough pain: a randomised trial comparing nasal and intravenous fentanyl in patients with p ost-operative pain. Presented at the 10th Congress of the European Association for Palliative Care, Budapest, Hungary, 7–9 June 2007
2. Gomez-Batiste X, Madrid F, Moreno F, Gracia A, Trelis J, Nabal M, Alcalde R, Planas J, Camell H. Breakthrough cancer pain: prevalence and characteristics in patients in Catalonia, Spain. Journal of Pain and Symptom Management 2002;24:45–52
3. Zeppetella G O’Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. Journal of Pain and Symptom Management 2000;20:87–92
4. Portenoy R and Hagen NA. Breakthrough pain; definition, prevalence, and characteristics. Pain 1990;41:273–281
5. Davies A. The art of breakthrough pain treatment. Presented in Challenges in treating breakthrough pain satellite symposium at the 10th Congress of the European Association for Palliative Care, Budapest, Hungary, 7 June 2007
6. Kaasa S. Challenges in breakthrough pain treatment. Presented in Challenges in treating breakthrough pain satellite symposium at the 10th Congress of the European Association for Palliative Care, Budapest, Hungary, 7 June 2007