Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Jandhyala, R; Fullarton, JR; Bennett, MI (2013)
Publisher: Elsevier
Journal: Journal of Pain and Symptom Management
Languages: English
Types: Article
Subjects: Anesthesiology and Pain Medicine, Clinical Neurology, Nursing(all)
Context: Breakthrough cancer pain (BTcP) is widely recognized as a clinically significant complication of chronic cancer pain. With most BTcP episodes peaking in intensity within a few minutes and lasting for approximately 30 minutes, speed of onset is crucial for effective pain management. Although the last decade has seen the development of a number of rapid-onset fentanyl preparations, BTcP is still typically managed by supplemental or rescue doses of the patient's around-the-clock medication, such as oral morphine. Importantly, although the fentanyl preparations, such as fentanyl buccal tablet (FBT), sublingual fentanyl citrate orally disintegrating tablet (ODT), and oral transmucosal fentanyl citrate lozenge (OTFC), have all been proven to be efficacious in clinical studies, oral morphine has never been specifically tested in BTcP, other than as a comparator in studies of OTFC and fentanyl pectin nasal spray. Objectives: To determine the relative contributions to pain relief from oral morphine and the fentanyl preparations using placebo as a common comparator. Methods: Relevant studies were identified by review of the literature and used in a mixed-treatment meta-analysis to indirectly compare fentanyl preparations, morphine, and placebo for the treatment of BTcP. Results: Analysis incorporating the five relevant studies identified revealed that although the fentanyl preparations provide superior pain relief vs. placebo in the first 30 minutes after dosing (FBT provided an 83% probability of superior pain relief, ODT 66%, and OTFC 73% vs. placebo), oral morphine performed little better than placebo (56% probability). Conclusion: This mixed-treatment analysis suggests that FBT, ODT, and OTFC might provide more efficacious treatment options than oral morphine for BTcP.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Droney J, Riley J. Recent advances in the use of opioids for cancer pain. J Pain Res 2009;2:135e155.
    • 2. World Health Organization. Cancer pain relief, 2nd ed. Geneva: World Health Organization, 1996.
    • 3. Ventafridda V, Tamburni M, Caraceni, et al. A validation study of the WHO method for cancer pain relief. Cancer 1987;59:850e856.
    • 4. Davies A, Dickman A, Reid C, et al. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 2009; 13:331e338.
    • 5. Zeppetella G, Ribeiro MDC. The pharmacotherapy of cancer-related episodic pain. Expert Opin Pharmacother 2003;4:493e502.
    • 6. Caraceni A, Martini C, Zecca E, et al. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 2004;3:177e183.
    • 7. Lossignol DA, Dumitrescu C. Breakthrough pain: progress in management. Curr Opin Oncol 2010;22:302e306.
    • 8. Dickman A. Basics of managing breakthrough cancer pain. Pharm J 2009;283:213e216.
    • 9. Greco MT, Corli O, Montanari M, et al. Epidemiology and pattern of care of breakthrough cancer pain in a longitudinal sample of cancer patients. Results from the Cancer Pain Outcome Research Study Group. Clin J Pain 2011;27:9e18.
    • 10. Mercadante S, Costanzo BV, Fusco F, et al. Breakthrough pain in advanced cancer patients followed at home: a longitudinal study. J Pain Symptom Manage 2009;38:554e560.
    • 11. Breivik H, Cherny N, Collett B, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 2009; 20:1420e1433.
    • 12. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999;81:129e134.
    • 13. American Pain Foundation. Breakthrough cancer pain: mending the break in the continuum of care. Available from www.painfoundation.org/ learn/publications/files/breakthrough-cancer-painreport.pdf. Accessed November 2011.
    • 14. Fortner BV, Demarco G, Irving G, et al. Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manage 2003;25:9e18.
    • 15. Fortner BV, Okon TA, Portenoy RK. A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain 2002;3:38e44.
    • 16. Zeppetella G. Opioids for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioid guidelines project. Palliat Med 2010;25:516e524.
    • 17. Vissers DCJ, Lenre M, Tolley K, et al. An economic evaluation of short-acting opioids for treatment of breakthrough pain in patients with cancer. Value Health 2011;14:274e281.
    • 18. Zeppetella G. Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 2008;35:563e567.
    • 19. Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain. Part 2: management. Pharm Ther 2005;30:354e361.
    • 20. Bennett D, Burton AW, Fishman S, et al. Consensus panel recommendations for the assessment and management of breakthrough pain. Part 1: assessment. Pharm Ther 2005;30:296e301.
    • 21. Davies AN, Vriens J, Kennett A, et al. An observational study of oncology patients' utilization of breakthrough pain medication. J Pain Symptom Manage 2008;35:406e411.
    • 22. Portenoy RK, Taylor D, Messina J, et al. A randomised, placebo-controlled study of fentanyl buccal tablet for breakthrough pain in opioidtreated patients with cancer. Clin J Pain 2006;22: 805e811.
    • 23. Slatkin N, Xie F, Messina J, et al. Fentanyl buccal tablet for relief of breakthrough pain in opioidtolerant patients with cancer-related chronic pain. J Support Oncol 2007;7:327e334.
    • 24. Rauck RL, Tark M, Reyes E, et al. Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 2009;25: 2877e2885.
    • 25. Farrar JT, Cleary J, Rauck R, et al. Oral transmucosal fentanyl citrate: randomized, doubleblinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients. J Natl Cancer Inst 1998;90:611e616.
    • 26. Coluzzi PH, Schwartzberg L, Conroy JD, et al. Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 2001;91:123e130.
    • 27. Jandhyala R, Fullarton JR. Various formulations of oral transmucosal fentanyl for breakthrough cancer pain: an indirect mixed treatment comparison metaanalysis. BMJ Support Palliat Care 2012;2:156e162.
    • 28. Lunn DJ, Thomas A, Best N, et al. WinBUGSda Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000;10:325e337.
    • 29. MRC Biostatistics Unit, Cambridge, UK. The BUGS project. Available from http://www.mrc-bsu. cam.ac.uk/bugs/. Accessed May 18, 2011.
    • 30. Cephalon UK Limited/Teva UK Limited. Clinical Study Report: Study No. 9914. Data on file.
    • 31. Cephalon UK Limited/Teva UK Limited. Clinical Study Report: Study No. 3039. Data on file.
    • 32. Cephalon UK Limited/Teva UK Limited. Study Summary Report. AC 200/013. Data on file.
    • 33. Cephalon UK Limited/Teva UK Limited. Study Summary Report. AC 600/001. Data on file.
    • 34. Vissers D, Stam W, Nolte T, et al. Efficacy of intranasal fentanyl spray versus other opioids for breakthrough pain in cancer. Curr Med Res Opin 2010;26:1037e1045.
    • 35. Weinstein SM, Messina J, Xie F. Fentanyl buccal tablet for the treatment of breakthrough pain in opioid-tolerant patients with chronic cancer pain. Cancer 2009;115:2571e2579.
  • No related research data.
  • Discovered through pilot similarity algorithms. Send us your feedback.

Share - Bookmark

Cite this article