Abstract
We differentiate 2 basic types of pain in cancer patients - basic pain and breakthrough pain. Each of them has different characteristics and for each of them we choose a different application form of opioid analgesics.
Breakthrough pain represents a serious clinical problem with a negative impact on the overall success of analgesic treatment, quality of life and healthcare utilization need. We further divide pain to spontaneous idiopathic pain without apparent evocatory cause, random incidental pain, which may be predictable after a certain activity or exercise and unpredictable pain during involuntary activities.
Pain at the end of the dosing interval of analgesics regularly administered for basic pain is also classified as breakthrough pain. Breakthrough pain emerges very fast within 3-5 minutes, has a short duration of 30-60 minutes in average and its average rate is 3-4 episodes per day.
Therefore an analgesic drug with a rapid onset and short duration of action, characterized by simple and safe application, is required. New forms of transmucosal fentanyl citrate, which are available in a sublingual and intranasal application form since early 2011, meet these requirements.
Other forms of analgesics with rapid onset, whose onset of action is longer than 30 minutes, are unsuitable for the treatment of breakthrough pain because of the slow onset of action and a high risk of accumulation. The prescription of modern application forms of opioid analgesics is limited to algesiologists and their use is economically highly demanding.
However they bring the advantage of reducing the number of hospitalizations and a decrease in healthcare consumption.