• Sebastiano Mercadante.
• University of Palermo, La Maddalena Cancer Center, Palermo and Department of Anesthesia, Intensive Care & Emergencies, Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit, Via san Lorenzo 312, 90145 Palermo, Italy. terapiadeldolore@lamaddalenanet.it
• Expert Opin Pharmacother. 2012 Apr 1;13(6):873-8.

IntroductionBreakthrough cancer pain has been defined as a transitory increase in pain intensity that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. The availability of supplemental doses of oral opioids, in addition to the continuous analgesic medication, is the main treatment suggested to manage pain flares.Areas CoveredOral transmucosal fentanyl citrate (OTFC) is the first product of a new generation of delivery systems, named rapid-onset opioids (ROOs), characterized by rapidity of effect and the short duration of analgesia. Controlled studies and long-term experience have shown that OTFC is an effective treatment for breakthrough pain management and its use should be considered in any patient experiencing breakthrough pain related to cancer.Expert OpinionThe onset of action of OTFC - demonstrated to start within 15 min - and the short time to maximum concentration make it a useful indication for breakthrough pain; dose titration is commonly recommended. However, it is likely that patients receiving high doses of opioids for background analgesia will not be candidates for titration with minimal initial doses of OTFC, as they are opioid tolerant and the process would be time consuming.

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