Skip to main content
SpringerLink
Log in

Tumordurchbruchschmerz

Indikation für schnell wirksame Opioide

Cancer breakthrough pain

Indications for rapidly effective opioids

  • Palliativmedizin
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Die Pharmakotherapie des Tumorschmerzes verfolgt zwei wesentliche Ziele: die adäquate Basisanalgesie mithilfe retardierter Opioiddauermedikation und die effektive Behandlung des Tumordurchbruchschmerzes mithilfe nichtretardierter, schnell wirksamer Opioide. Der Durchbruchschmerz ist durch einen plötzlich einsetzenden, schnellen Anstieg des Schmerzniveaus charakterisiert und sollte mit entsprechend schnell wirksamen Opioiden behandelt werden. Die pharmakologischen Eigenschaften der bisher verfügbaren und regelmäßig eingesetzten nichtretardierten Opioide entsprechen in der oralen Galenik nicht immer den aus der Definition des Tumordurchbruchschmerzes hervorgehenden Anforderungen. Als Alternative zu diesen Substanzen stehen mittlerweile 5 verschiedene schnell wirksame Fentanylformulierungen zur transmukosalen Anwendung zur Verfügung.

Abstract

The pharmacotherapy of tumor pain has two main aims: to deliver an adequate basic analgesia using long-term retarded opioid medication and an effective treatment of tumor breakthrough pain using rapidly effective non-retarded opioids. Breakthrough pain is characterized by a sudden onset and rapid increase in the pain level and should be treated with correspondingly rapidly effective opioids. The pharmacological characteristics of previously available and routinely prescribed non-retarded opioids do not always correspond in oral galenics to the demands resulting from the definition of tumor breakthrough pain. As alternatives to these substances five different rapidly effective fentanyl preparations are now available for transmucosal administration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Hanks GW, Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593

    Article  PubMed  CAS  Google Scholar 

  2. Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41(3):273–281

    Article  PubMed  CAS  Google Scholar 

  3. Svendsen KB, Andersen S, Arnason S et al (2005) Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 9(2):195–206

    Article  PubMed  Google Scholar 

  4. Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain 82(3):263–274

    Article  PubMed  CAS  Google Scholar 

  5. Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433

    Article  PubMed  CAS  Google Scholar 

  6. Fortner BV, Demarco G, Irving G et al (2003) Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manage 25(1):9–18

    Article  PubMed  Google Scholar 

  7. Slatkin NE, Xie F, Messina J, Segal TJ (2007) Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. J Support Oncol 5(7):327–334

    PubMed  CAS  Google Scholar 

  8. Labroo RB, Paine MF, Thummel KE, Kharasch ED (1997) Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implications for interindividual variability in disposition, efficacy, and drug interactions. Drug Metab Dispos 25(9):1072–1080

    PubMed  CAS  Google Scholar 

  9. Cawley MM, Benson LM (2005) Current trends in managing oral mucositis. Clin J Oncol Nurs 9(5):584–592

    Article  PubMed  Google Scholar 

  10. Payne R, Coluzzi P, Hart L et al (2001) Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. J Pain Symptom Manage 22(1):575–583

    Article  PubMed  CAS  Google Scholar 

  11. Jobbins J, Bagg J, Finlay IG et al (1992) Oral and dental disease in terminally ill cancer patients. BMJ 304(6842):1612

    Article  PubMed  CAS  Google Scholar 

  12. Streisand JB, Varvel JR, Stanski DR et al (1991) Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75(2):223–229

    Article  PubMed  CAS  Google Scholar 

  13. Prommer E (2009) The role of fentanyl in cancer-related pain. J Palliat Med 12(10):947–954

    Article  PubMed  Google Scholar 

  14. Lichtor JL, Sevarino FB, Joshi GP et al (1999) The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg 89(3):732–738

    PubMed  CAS  Google Scholar 

  15. Coluzzi PH, Schwartzberg L, Conroy JD et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91(1–2):123–130

    Google Scholar 

  16. Zeppetella G (2008) Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 35(5):563–567

    Article  PubMed  Google Scholar 

  17. Ashburn MA, Lind GH, Gillie MH et al (1993) Oral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain. Anesth Analg 76(2):377–381

    PubMed  CAS  Google Scholar 

  18. Sharar SR, Bratton SL, Carrougher GJ et al (1998) A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 19(6):516–521

    Article  PubMed  CAS  Google Scholar 

  19. Sharar SR, Carrougher GJ, Selzer K et al (2002) A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabil 23(1):27–31

    Article  PubMed  CAS  Google Scholar 

  20. Mahar PJ, Rana JA, Kennedy CS, Christopher NC (2007) A randomized clinical trial of oral transmucosal fentanyl citrate versus intravenous morphine sulfate for initial control of pain in children with extremity injuries. Pediatr Emerg Care 23(8):544–548

    Article  PubMed  Google Scholar 

  21. Lennernas B, Hedner T, Holmberg M et al (2005) Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: a new approach to treatment of incident pain. Br J Clin Pharmacol 59(2):249–253

    Article  PubMed  CAS  Google Scholar 

  22. Rauck RL, Tark M, Reyes E et al (2009) Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 25(12):2877–2885

    Article  PubMed  CAS  Google Scholar 

  23. Darwish M, Tempero K, Kirby M, Thompson J (2006) Relative bioavailability of the fentanyl effervescent buccal tablet (FEBT) 1,080 pg versus oral transmucosal fentanyl citrate 1,600 pg and dose proportionality of FEBT 270 to 1,300 microg: a single-dose, randomized, open-label, three-period study in healthy adult volunteers. Clin Ther 28(5):715–724

    Article  PubMed  CAS  Google Scholar 

  24. Dale O, Hjortkjaer R, Kharasch ED (2002) Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand 46(7):759–770

    Article  PubMed  CAS  Google Scholar 

  25. Shelley K, Paech MJ (2008) The clinical applications of intranasal opioids. Curr Drug Deliv 5(1):55–58

    Article  PubMed  CAS  Google Scholar 

  26. Foster D, Upton R, Christrup L, Popper L (2008) Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Ann Pharmacother 42(10):1380–1387

    Article  PubMed  CAS  Google Scholar 

  27. Coda BA, Rudy AC, Archer SM, Wermeling DP (2003) Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. Anesth Analg 97(1):117–123, table of contents

    Article  PubMed  CAS  Google Scholar 

  28. Kress HG, Oronska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31(6):1177–1191

    Article  PubMed  CAS  Google Scholar 

  29. Mercadante S, Radbruch L, Davies A et al (2009) A comparison of intranasal fentanyl spray with oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: an open-label, randomised, crossover trial. Curr Med Res Opin 25(11):2805–2815

    PubMed  CAS  Google Scholar 

  30. Kaasa S, Moksnes K, Nolte T et al (2010) Pharmacokinetics of intranasal fentanyl spray in patients with cancer and breakthrough pain. J Opioid Manag 6(1):17–26

    PubMed  Google Scholar 

  31. Portenoy RK, Burton AW, Gabrail N, Taylor D (2010) A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain 151(3):617–624

    Article  PubMed  CAS  Google Scholar 

  32. Fisher A, Watling M, Smith A, Knight A (2010) Pharmacokinetics and relative bioavailability of fentanyl pectin nasal spray 100–800 microg in healthy volunteers. Int J Clin Pharmacol Ther 48(12):860–867

    PubMed  CAS  Google Scholar 

  33. Portenoy RK, Raffaeli W, Torres LM et al (2010) Long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray for breakthrough cancer pain in opioid-tolerant patients. J Opioid Manag 6(5):319–328

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anaesthesiologie, Zentrum für Schmerztherapie und Palliativmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 131, 69120, Heidelberg, Deutschland

    J. Keßler & H.J. Bardenheuer

Authors
  1. J. Keßler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.J. Bardenheuer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Keßler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keßler, J., Bardenheuer, H. Tumordurchbruchschmerz. Anaesthesist 60, 674–682 (2011). https://doi.org/10.1007/s00101-011-1868-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-011-1868-1

Schlüsselwörter

Keywords

Search

Navigation