University of Athens, Areteion Hospital, School of Medicine, Pain Relief and Palliative Care Unit, Department of Radiology, 27 Korinthias Street, 115 26 Athens, Greece.
Expert Opin Pharmacother. 2011 Jul;12(10):1653-9. doi: 10.1517/14656566.2011.585637. Epub 2011 May 24.
Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated.
Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients.
The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.
爆发性疼痛是一种慢性疼痛得到控制的患者中短暂的疼痛加剧，在癌症患者中已经得到很好的描述，但尽管医学上已经有所认识，这种情况有时仍然诊断不足，因此治疗不足。
枸橼酸芬太尼口腔黏膜贴片（OTFC）和芬太尼颊片剂是专门为治疗阿片类药物耐受患者爆发性疼痛而开发的首批药物。由于许多癌症患者不能口服芬太尼，因此开发了经鼻芬太尼喷雾（INFS）作为一种更有效的给药方法。与口服/胃肠道途径相比，经鼻给予芬太尼具有许多优势，临床试验表明，它优于 OTFC，同时具有良好的耐受性，大多数患者更容易接受。
本综述的目的是总结过去几年中 INFS 的药理学特性和临床研究数据，并介绍目前在欧盟获得批准的新型经鼻给予芬太尼制剂——PecFent。最后，我们讨论了它在未来癌症患者爆发性疼痛管理中的可能影响，因为准确的诊断加上最佳的治疗对于有效缓解疼痛至关重要。
