Prescrire Int. 2002 Aug;11(60):106-7.
(1) Some cancer patients suffer occasional breakthrough pain despite well-conducted opiate treatment, warranting the use of immediate-release oral morphine. (2) A fentanyl preparation for oral transmucosal administration has just been granted this indication in France. (3) The evaluation file mainly contains results from a randomised double-blind cross-over trial comparing transmucosal fentanyl with oral morphine tablets in cancer patients. It showed a small gain in terms of rapidity and efficacy of pain relief with fentanyl relative to morphine, but this was of dubious clinical relevance. (4) The adverse effects of oral transmucosal fentanyl are those of all opiates, such as drowsiness, dizziness, nausea, vomiting and confusion. (5) The oral transmucosal fentanyl preparation has the taste and appearance of a lollipop, and may therefore be attractive to children. The packaging seems to take this risk into account, but precautions must be taken to keep this treatment away from children, especially after opening. (6) Immediate-release oral morphine remains the standard treatment for breakthrough pain in patients receiving opiate therapy. If it is inadequate, oral transmucosal fentanyl may sometimes be slightly better.
（1）一些癌症患者尽管接受了规范的阿片类药物治疗，但仍偶尔会出现突破性疼痛，因此有必要使用即释型口服吗啡。（2）一种用于口腔黏膜给药的芬太尼制剂刚刚在法国获得了这一适应症。（3）评估文件主要包含一项随机双盲交叉试验的结果，该试验比较了癌症患者口腔黏膜芬太尼与口服吗啡片的效果。结果显示，与吗啡相比，芬太尼在缓解疼痛的速度和效果方面略有优势，但这在临床相关性上存疑。（4）口腔黏膜芬太尼的不良反应与所有阿片类药物相同，如嗜睡、头晕、恶心、呕吐和意识模糊。（5）口腔黏膜芬太尼制剂的味道和外观像棒棒糖，因此可能会吸引儿童。包装似乎考虑到了这种风险，但必须采取预防措施，使这种治疗远离儿童，尤其是在开封后。（6）即释型口服吗啡仍然是接受阿片类药物治疗患者突破性疼痛的标准治疗方法。如果效果不佳，口腔黏膜芬太尼有时可能会稍好一些。
