Pain management
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SUMMARY Fentanyl buccal tablets (FBT) have been designed to treat breakthrough pain (BTP) in patients who are already receiving, and who are tolerant to, opioid therapy for their underlying persistent pain. FBT are a formulation that uses an effervescent drug delivery system to enhance penetration across the buccal mucosa. OraVescent technology provides an effervescent reaction that liberates carbon dioxide in the buccal cavity. ⋯ The safety and tolerability profile is generally typical of that observed with other opioids. The pharmacokinetic properties of FBT allow for a meaningful clinical efficacy, with an onset of action that closely matches the onset of BTP. FBT, as with any other transmucosal preparations of fentanyl, should not be used in patients who are not opioid-tolerant.
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Nanna Finnerup graduated from the Medical School at Aarhus University, Denmark, in 1993, and after an internship worked at the Department of Neurology and Clinical Neurophysiology at the University of Copenhagen, Denmark. Since 1998 she has worked at the Danish Pain Research Center at Aarhus University. ⋯ Dr Finnerup is a Management Committee Member of the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain and a board member of the Scandinavian Association for the Study of Pain (SASP). She is a member of the Editorial Advisory Board of the Scandinavian Journal of Pain, the Encyclopedia of Pain and Pain Management.
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SUMMARY ⋯ In this observational study in normal clinical practice, transdermal buprenorphine provided effective pain relief and was generally well tolerated by patients with cancer pain. It also improved quality of life for patients and reduced caregiver burden. Considering the high number of study discontinuations (mainly due to nontreatment-related death and lost to follow-up), the results of this study need to be evaluated with caution.
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SUMMARY An extended-release, multivesicular liposome-encapsulated form of the local anesthetic bupivacaine, DepoFoam(®) bupivacaine (proposed proprietary name EXPAREL™), is in development for use as part of a multimodal regimen for the treatment of postsurgical pain. Placebo- and active-controlled clinical trials in patients who have undergone either orthopedic or soft-tissue procedures indicate that a single local administration into the surgical site results in analgesic activity for up to 3-4 days and decreases the use of opioid rescue medication. The safety profile of DepoFoam bupivacaine appears to be similar to that of bupivacaine HCl, and adverse events are dose-related.