Resultados en salud y eficiencia del fentanilo intranasal en pectina en el dolor irruptivo en la práctica clínica habitual

Blanco, Bruno Anjos; Ruíz, Antonio; Soler, Nuria García‐Agua

doi:10.4321/s1134-80462013000500004

Cited by 5 publications

(1 citation statement)

References 19 publications

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“…Our final recommendation to the Pharmacy Committee in our institution to introduce ROOs in our hospital formulary was also supported by two recent pharmacoeconomic studies performed in Spain. In the first study, all ROOs were cost-effective in terms of willingness to pay per years gained with good quality of life [ 10 ]. In the second study, a 4-year model of the budget impact of ROOs was developed for the period 2012–2015 for patients with BTcP from the perspective of the public Spanish National Health System, which tightly regulates the cost of ROOs in the country [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Breakthrough cancer pain and rational drug use

Olarte

2017

Support Care Cancer

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Recent data indicate that there are large disparities in the use of opioid analgesics to control breakthrough cancer pain (BTcP) in Europe and worldwide. While it is clear that affordability is a key factor, it is certainly not the only one, and other factors, such as cultural differences and overall awareness, are undoubtedly responsible. More work remains to be done to overcome barriers in the use of these medications when warranted. When prescribing a medication for BTcP, it must be considered that its time profile is different from chronic persistent pain. The best control of background pain can best be achieved with a low dose of an extended opioid, and managing BTcP with a rapid-onset opioid, providing a good combination of overall pain control and lower opioid exposure. Notwithstanding their efficacy, greater attention needs to be paid to inappropriate use of opioids. It is important to evaluate patients for potential opioid misuse, including assessment of risk factors, and aberrant drug-taking behaviours must be investigated. In our institution, several measures have been adopted in this patient population in order to prevent aberrant opioid-induced behaviours. The adoption of some or all of these principles, depending on the individual patient and treatment setting, can undoubtedly help to reduce the risk of developing an aberrant behaviour related to opioid use as rescue medication for BTcP.

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Section: Introductionmentioning

confidence: 99%

Breakthrough cancer pain and rational drug use

Olarte

2017

Support Care Cancer

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Facilitation of accurate and effective radiation therapy using fentanyl pectin nasal spray (FPNS) to reduce incidental breakthrough pain due to procedure positioning

Prieto

Pardo

Luna

et al. 2016

Scandinavian Journal of Pain

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AbstractPurposeTo provide effective and accurate radiotherapy (RT) for advanced cancer patients who experience breakthrough pain (BP) due to positioning manoeuvres, through the use of FPNS. Secondary endpoints were the dose and time required to achieve a 50% numeric rating scale (NRS) reduction and conduction of a pharmacoeconomic analysis.Patients and methodsTwenty-seven advanced cancer patients with moderate-severe BP associated with routine radiotherapy procedures and manoeuvres were selected to receive FPNS. Most patients (20/27) had bone metastases. The patients showed a low Karnovsky performance status (mean 54%; range: 30–80). BP intensity was scored with the NRS before and after the procedures that triggered it. All patients were already receiving opioid baseline treatment at a total dose equivalent to 40–160 mg oral morphine. Before the procedure, BP was treated with 100-400 μg of FPNS. Data related to tolerance, pain relief, onset of the relief and efficient dose to allow RT to proceed were collected.Results In 26 patients the BP score was reduced by at least 50% as determined in 15.5 min (range 8-35 min) after fentanyl pectin intranasal administration, and pain relief started after 7 min (range 3–15 min); p <0.05 in both cases. The duration of pain reduction facilitated the proceeding of RT. The Mean NRS score before the procedure was 9 (95%CI: 8.6–9.4) and decreased during procedure to 3 (95%CI: 2.5–3.8). The average dose of FPNS for most patients was 100-200 to achieve pain control, except in three patients who required progressive doses of up to 300–400 μg. After receiving 300 μg, one patient dropped out of the study due to severe adverse effects (nausea). Seven patients reported minor undesirable effects related to FPNS administration.Conclusions and implicationsCertain necessary RT procedures in advanced cancer patients can cause severe BP episodes. A simple, safe, fast acting and strong analgesic is needed. FPNS is a rapidly absorbed opioid analgesic with a pain relief profile that would be particularly well suited for this patient population. By reducing BP, the drug enables the completion of necessary RT procedures without needless patient discomfort. When BP is attenuated, Department productivity is maintained and unnecessary delays are avoided. Further studies and clinical trials are needed to assess therapeutic FPNS dosages with a view to defining efficacy in the correct clinical context.

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