ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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| Title |
Fentanyl Pectin Nasal Spray Reduced Oral-Cancer Related Pain |
| Clinical Question |
In a patient with oral cancer, is fentanyl pectin nasal spray (FPNS) compared to immediate-release morphine sulfate (IRMS) more effective in reducing oral cancer related pain? |
| Clinical Bottom Line |
Fentanyl pectin nasal spray is more effective in reducing oral cancer related pain than immediate-release morphine sulfate. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 22055892 | Fallon/ 2011 | Oral cancer patients (n=110) experiencing cancer pain 1-4 episodes/ day | Randomized Controlled Trial | | Key results | There was statistically significant improvement in pain intensity difference (PID) at 15 minutes after dosing of fentanyl pectin nasal spray (FPNS) compared with immediate release morphine sulfate (IRMS) (p<. 05) which had onset of at least 30 minutes. FPNS had an onset of pain intensity improvement in 57.5% of episodes at 5 minutes and 95.7% of the episodes by 30 minutes. Whereas IRMS had no significant effects until 30 minutes post-treatment. More adverse effects (AE) were related to FPNS than IRMS treatment. Eight patients reported fourteen serious AE, but most serious AEs were considered to be unrelated to the study drug. | |
| Evidence Search |
"Fentanyl"[Mesh] AND ("Administration, Intranasal"[Mesh] OR "Nasal Sprays"[Mesh]) Limits: Randomized Controlled Trial |
Comments on
The Evidence |
The study was a double blind randomized controlled trial. Oral cancer patients at start were all receiving opioid regimens of > 60 mg/ day oral morphine for cancer-related pain and had 1-4 episodes/ day. 110 patients were enrolled in the study and 79 patients completed the study. 10 episodes were treated (5 with FPNS and 5 with IRMS) for each patient. Compliance was adequate with sufficient follow up. Recall bias was unlikely. |
| Applicability |
Fentanyl pectin nasal spray is effective at delivering significant rapid reductions in pain that were greater than the effect of IRMS and was able to provide a longer duration of pain relief in the break through cancer pain episodes. |
| Specialty/Discipline |
(Public Health) (Oral Medicine/Pathology/Radiology) (Basic Science) |
| Keywords |
oral cancer, pain, fentanyl pectin nasal spray, break through pain
|
| ID# |
2270 |
| Date of submission: |
04/19/2012 |
| E-mail |
kusbel@livemail.uthscsa.edu |
| Author |
Marisol Kusbel |
| Co-author(s) |
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| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Cara Gonzales, PhD, DDS |
| Faculty mentor/Co-author e-mail |
gonzalesc5@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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