A New Year's Wish for 2008: No More Breakthrough Pain

Dr. Mark Borigini Health Guide
  • It is well known that breakthrough pain (BTP) remains the scourge of those who suffer from chronic pain. It seems these patients cannot experience any sort of reasonable prolonged relief.


    Fentanyl buccal tablets (FBT) have been used for quite a long time for cancer-related BTP, and in fact is FDA-approved for this indication. But there have been a number of studies looking at FBT in noncancer pain. More specifically, the noncancer pain studied recently has been neuropathic pain and low back pain.


    Interestingly, patients with diabetic neuropathy, traumatic injury, radiculopathy, postherpetic neuralgia, to name a few, who experience breakthrough pain and are also opioid-tolerant who are given FBT experience a rather rapid relief of pain. Compared to placebo, FBT gave a significant amount of pain relief which continued for about two hours.

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    Recent studies have shown that FBT is helpful for BTP associated with both neuropathic pain and low back pain. There were less BTP episodes and improvement in pain intensity. FBT achieved pain improvement compared to placebo in ten minutes with neuropathic pain, and in fifteen minutes with low back pain.


    Short-acting opioids such as oxycodone and morphine do not have such good data concerning onset of action. However, there are ongoing studies which are examining the benefit of such short-acting drugs versus FBT.


    Patients do feel significant pain relief with FBT. They feel FBT is better compared to other drugs they have used for breakthrough pain. And they feel that FBT is good to excellent in terms of onset of action, ease of administration, and convenience of use.


    Many doctors still need a greater awareness of the proper pain management of the chronic pain patient. This of course includes the proper use of opioids, and how doctor and patient deal with side effects and the potential for abuse. As many of us know, there has been much in the media regarding the abuse of prescription narcotics, but we all must not forget the proper use of these pain medications and their role in relieving suffering.


    The treatment of BTP will most likely continue to require the skillful use of multiple medications. Opioids will often need to be used in combination with drugs for chronic pain, such as Lyrica and Cymbalta. The use of FBT with these drugs may produce a siginicantly greater benefit to chronic pain sufferers.


    So, as the year 2007 draws to a close, I wish everyone a Happy New Year. As you can see, research continues, and new drugs and drug combinations are being studied, just as new indications for old drugs are being discovered. One should never lose hope. One can never lose hope.


    I wish you all Good Fortune and Good Health in 2008.

Published On: December 27, 2007