Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen

Conventional opioid therapy consists of the regular administration of extended-release opioids following fixed time intervals and, as needed, the supplemental use of an immediate-release formulation. For the patient needs of such rescue medication, recent studies distinguished different scenarios, such as an inadequate daily opioid dose or time interval (end-of-dose failure) from so-called breakthrough pain where the attacks can suddenly occur either spontaneously (idiopathic pain) or due to certain provocations (incident pain) despite optimal dose adjustment. In line with this time course, a fast and short-lasting elevation of the opioid plasma concentration seems to be reasonable. Although in a recent European survey breakthrough pain attacks in the majority of cancer pain patients were sufficiently treated with immediate-release opioids, currently running clinical trials examine whether the application of transmucosal or intranasal fentanyl with their known reduced time to maximum plasma concentrations show a possible advantage in comparison to immediate-release opioids. In these clinical trials the pain intensity and number of pain episodes were significantly reduced following transmucosal or intranasal fentanyl; however, the magnitude of these effects does not convincingly appear to be clinically relevant. Among other reasons this may be related to the fact that those patients who would perhaps benefit from such treatment have not yet been identified.

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Durchbruchschmerzen und kurz wirksame Opioide

Beutlhauser¹,

Oeltjenbruns²,

Schäfer³

2013

Anaesthesist

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Palliativmedizinische Behandlung von gynäkologischen Malignomen und Mammakarzinomen

Schubert,

Korff,

Rieke

et al. 2024

Gynäkologie

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Schnell freisetzende Fentanylapplikationsformen

Wirz¹,

Wiese

Zimmermann

et al. 2013

Schmerz

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The spectrum of indications for rapid release fentanyl preparations is controversial. For this reason the Working Group on Tumor Pain will formulate comments on how to deal with these substances. Breakthrough pain should receive individualized therapy; therefore, the use of opioids of various galenic formulations seems to be advisable. New rapid release fentanyl preparations are suitable for alleviating spontaneous breakthrough pain in tumor patients due to a rapid but short-acting effect. However, a prior optimization of the analgesic basis medication is absolutely necessary. Uncontrolled prescription for non-cancer pain must be criticized due to the problem of addiction. The medical profession should be informed about the benefits of rapid release fentanyl preparations but must also be made aware of the risk of a rapid development of addiction and tolerance. A self-commitment of the pharmaceutical industry to waive advertising for the dangerous off-label use would be desirable. In the opinion of the Working Group on Tumor Pain the use of fentanyl should be openly discussed and further scientific investigations are imperative with the aim of formulating clear recommendations.

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Erfahrungen von Tumorpatienten mit Durchbruchschmerzen und medikamentösen Behandlungen

Cited by 6 publications

References 25 publications

Durchbruchschmerzen und kurz wirksame Opioide

Durchbruchschmerzen und kurz wirksame Opioide

Palliativmedizinische Behandlung von gynäkologischen Malignomen und Mammakarzinomen

Schnell freisetzende Fentanylapplikationsformen

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