Zeppetella, G., Davies, A., Eijgelshoven, I., & Jansen, J.P. (2014). A network meta-analysis of the efficacy of opioid analgesics for the management of breakthrough cancer pain episodes. Journal of Pain and Symptom Management, 47, 772–785.e5.
STUDY PURPOSE: To identify the relative value of current approved medications for breakthrough pain
TYPE OF STUDY: Meta-analysis and systematic review
APPLICATIONS: Palliative care
Intranasal fentanyl spray (INFS), fentanyl pectin nasal spray, fentanyl buccal soluble film, fentanyl sublingual tablets, fentanyl buccal tablets, oral transmucosal fentanyl citrate, and immediate-release morphine sulfate were all superior to a placebo. All medications other than morphine sulfate were superior at 15 minutes, and INFS provided the greatest effect in this timeframe. There was evidence that INFS was most effective compared to others at five minutes. However, these data were of lower quality. Overall, the studies were of high quality.
All of the current approved medications for breakthrough pain were effective. Transmucosal agents and INFS were effective more quickly than immediate-release oral morphine.
None identified
The findings of this meta-analysis suggest that transmucosal and intranasal medication for breakthrough pain are effective more rapidly than immediate-release oral morphine. These should be considered for the management of breakthrough pain, according to patient tolerance and preferences. INFS could be considered the treatment of choice for patients with rapid-onset and short-duration breakthrough pain.