Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
LOPEZ, E.; TOVAR, I.; ROMERO, J. y ZURITA, M.. Analgesic efficacy of oral transmucosal fentanyl citrate in rectal breakthrough pain in oncologic patients. Rev. Soc. Esp. Dolor [online]. 2010, vol.17, n.1, pp.16-21. ISSN 1134-8046.
Objective: Breakthrough pain is a little-known entity that is infrequently diagnosed and consequently inadequately evaluated and treated. In particular, cancer patients can experience rectal defecation breakthrough pain due to the tumor, the side effects of treatment (surgery, radiotherapy and/or chemotherapy) or both. Recently, a new system of administration has been developed, oral transmucosal fentanyl citrate (OTFC; Actiq®), which is a highly efficient method for rapid onset of analgesia. The aim of this study was to evaluate the efficiency of OTFC as an analgesic for a highly specific subgroup of cancer patients. Patients and methods: We retrospectively reviewed 10 cancer patients treated with OTFC for rectal defecation breakthrough pain not previously treated with opioids between January 2006 and July 2009 in our Radiotherapy Service. Patients reporting rectal pain in consultations were evaluated by a Visual Analog Scale (VAS) (0-10). Results: The mean breakthrough pain VAS score was reduced from 7 (range 5-9) before OTFC to 1.9 (range 1-3) after the treatment. All patients reported pain control with a dose of 200 µg of OTFC except two patients who required progressive doses of 400 and 600 µg, respectively. The degree of patient satisfaction was excellent-good in 90% of the patients. No patients reported undesirable effects related to the use of OTFC. Conclusions: Although our series is small and our results are therefore preliminary, we can recommend OTFC as the ideal analgesic due to its speed of onset and safety in the treatment of rectal defecation breakthrough pain. OTFC is easy and comfortable to administer and is short lasting. This option can be used by patients outside the home, thus preserving their independence. OTFC can be considered for the relief of breakthrough pain of other etiologies (oncological and non-oncological) in outpatients.
Palabras clave : OTFC (oral transmucosal fentanyl citrate); Breakthrough pain; Analgesic; Safety; Effectiveness.