Effectiveness of Fentanyl Pectin Nasal Citrate in Controlling Breakthrough Pain Episodes Caused by Routine Radiation Therapy Procedures

Abstract

To evaluate effectiveness of fentanyl pectin nasal citrate (FPNC) in controlling breakthrough pain episodes (BPE) in cancer patients (pts) undergoing radiotherapy provoked by routine radiotherapy procedures that impede its realization. Fifty eight consecutive pts, who presented BPE associated to routine radiotherapy procedures (simulation, imaging acquisition and treatment administration) that impeded its accomplishment, were included in the study. BPE intensity was evaluated by Visual Analog Scale (VAS) after the procedure that triggered them, and after the administration of FPNC. All pts described a very high VAS value (mean: 8.8; range: 7-10) related with the specific procedure. The administration of FPNC was performed according our department protocol. 87.9% of the pts were already receiving an opioid basal treatment equivalent to 40-160 mg morphine. For every FPNC administration, data related to response, degree of pain relief, onset of the relief, need of new FPNC administration and fulfilment of the procedure were collected. Age: Mean 62.5 years (range: 42-89). Gender: 36 males and 22 females. Primary tumor: lung 24 pts, prostate 12, breast 11, gynecological 4, digestive 2 and others 5. 53 pts (91.3%) suffered from bone metastases. Procedure that triggered the BPE: Simulation 46 pts and treatment administration 12. In 49 pts (84.5%) VAS score was reduced to 4.8 (range 2-6) after 4.5 minutes (range: 2-10) of first FPNC administration. 9 pts (15.5%) dis not responded after 15 minutes and required a second dose of FPNC. All of them responded and the VAS score was reduced to 4.6 (range 4-6) after 3 minutes of second administration. No side effects related to the FPNC administration were reported. In 84.5% of the patients the procedure was performed after 4.5 minutes. Some procedures in the radiotherapy process may trigger BPE episodes which impede its accomplishment. In our study, FPNC has proven to be very effective in the BPE management, allowing the accomplishment of these procedures in a short time, avoiding delays and unnecessary suffering to patients.