Background: Most of the patients suffering from head and neck cancer has nociceptive or neuropathic pain and BTcP. They are not in degree to swallow and need adequate cancer pain therapy. We have formulated a therapy using Fentanyl patches trans- dermal and Intranasal fentanyl pectin.Breakthrough cancer pain (BTcP) is reported by about two-thirds of patients treated with opioids for cancer-related pain. Fentanyl is widely used to treat BTcP because it has a rapid onset, a short duration of action. Intranasal administration achieves rapid absorption and avoids the unpredictable variation in first-pass metabolism associated with oral administration. PecFent is formulated as a pectin-based gel designed to allow rapid absorption but avoiding high peak serum levels of fentanyl.It is an intranasal spray delivering 100 or 400 µg fentanyl per spray. We used this formulation for the management of BTcP in adults who were already receiving maintenance opioid therapy for chronic cancer pain.BTcP is defined as a transitory exacerbation of pain that occurs ona background of otherwise controlled persistent pain. Materials and methods: 37 patients suffering from cancer pain with NRS between 6 and 9, Karnofsky 50/60 were enrolled. These patients with neoplasia of the head and neck had basic pain 6-9 and 3-4 episodes of BTcP. We performed titration by intravenous morphine, for having the right dose of fentanyl to be administered. To manage the basic pain we administered fentanyl patch trans dermal with specific dose adjustment. To treat BTcP we used fentanyl thickened with pectin in intranasal formulations. Results: We reached Nrs 3-4, through therapy with Fentanyl patch and PecFent spray. Conclusion: Clinical management of breakthrough cancer pain in patients with malignancies of the District Head - Neck can be satisfactorily done with Fentanyl patch and intranasal fentanyl pectin for better compliance in a Patient with many therapies.