A range of frequently asked questions asked by healthcare professionals about breakthrough cancer pain.

What can you do to treat very short episodes of breakthrough pain (i.e. < 5 min)

Most “rescue medications” have an onset of action of > 5min, and so are not useful in this situation. The options for management include treatment of the underlying cause of the pain, avoidance / treatment of the precipitating factors of the pain, modification of the background analgesic regimen, and use of non-pharmacological methods, use of interventional techniques.

Can oral opioids provide pain relief before 20-30 min?

Oral opioids have an onset of action of 20-30 min, and so pain relief before this time invariably reflects spontaneous improvement of the pain (rather than an effect of the drug).

Can a patient take Abstral® / Actiq® / Effentora® / Instanyl® more than four times a day?

The marketing authorisation / summary of product characteristics for these products state that they should not be used more than four times a day. The reason for this statement is that the patients in the pivotal clinical trials were not allowed to take these products more than four times a day. However, it may be appropriate to use these products more often in clinical practice, although the frequent use of these products may reflect the need for other therapeutic options.

Can a patient take Abstral® / Actiq® / Effentora® / Instanyl® to try to prevent the onset of pain?

The marketing authorisation / summary of product characteristics for these products do not state that they could be used to try to prevent the onset of pain. The reason for the absence of such a statement is that none of the pivotal clinical trials addressed this method of treatment. However, it is entirely appropriate to use these products in this way in clinical practice.

Can a patient with a dry mouth use Abstral® / Actiq® / Effentora®?

Patients with a dry mouth may have difficulty in using Abtral® / Actiq® / Effentora®. The summary of product characteristics for these products recommend the use of a small amount of water in this situation, although there is no evidence to support this suggestion (and anecdotal evidence to dispute this suggestion). The alternative options are to treat the dry mouth, or to use an alternative route of administration (e.g. intranasal route of administration).

Can a patient with a “cold” / allergic rhinitis use Instanyl®?

Studies suggest that the pharmacokinetic profile of Instanyl® is not affected by the presence of a “cold” or allergic rhinitis (and use of vasoconstrictors), and so the implication is that patients with these conditions can use Instanyl®.

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