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Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
Resumen
GASENT BLESA, JM et al. Sublingual fentanyl for the treatment of breakthrough cancer pain during allergic reactions to chemotherapy infusion. Rev. Soc. Esp. Dolor [online]. 2019, vol.26, n.3, pp.148-153. Epub 23-Mar-2020. ISSN 1134-8046. https://dx.doi.org/10.20986/resed.2018.3689/2018.
Introduction:
Drug hypersensitivity reactions (DHR) are events that can occur during the administration of several chemotherapeutic agents and which could potentially be life-threatening. These events may present with intense pain, in some cases known as breakthrough cancer pain (BTCP). There are no currently available treatment guidelines for this specific type of pain.
Objectives:
To assess the efficacy of sublingual fentanyl citrate 100 mcg in cancer patients in the treatment of DHR-related BTCP during chemotherapy infusion.
Material and methods:
A retrospective study with patients receiving chemotherapy in the Medical Oncology Department of Hospital de Denia between 2013 and 2016 who were treated with fentanyl due to DHR-related BTCP (VAS [Visual Analogue Scale] > 7). BTCP severity was determined via a VAS before and after fentanyl administration. Student's t-test was used to compare VAS scores before and after the treatment.
Results:
A total of 34 patients were included (73.53 % women; mean age: 59.68 y/o). The chemotherapy treatments that were most frequently associated with the occurrence of DHR-related BTCP were docetaxel and oxaliplatin (both 35.29 %), followed by paclitaxel (20.59 %). On average, patients had a baseline VAS score of 8.55 (SD 0.79) before being treated with fentanyl. After treatment, the mean pain intensity was 1.48 (SD 1.50), which represented a significant difference (p < 0.001). The mean duration of the BTCP episode was of 5.29 minutes (SD 2.25), and the mean time to achieve pain relief was 1.52 minutes (SD 0.71).
Conclusions:
Sublingual fentanyl is an effective drug in the management of DHR-related BTCP during the infusion of taxanes and oxaliplatin, as it provides for a rapid and significant pain relief. Its role in this context should be further investigated by means of controlled clinical trials.
Palabras clave : Infusion allergic reactions; breakthrough cancer pain; fentanyl; sublingual.