• Kyriaki Mystakidou, Irene Panagiotou, and Athanasios Gouliamos.
• University of Athens, Areteion Hospital, School of Medicine, Pain Relief and Palliative Care Unit, Department of Radiology, 27 Korinthias Street, 115 26 Athens, Greece. mistakidou@yahoo.com
• Expert Opin Pharmacother. 2011 Jul 1;12(10):1653-9.

IntroductionBreakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated.Areas CoveredOral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients.Expert OpinionThe aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.© 2011 Informa UK, Ltd.

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