Addressing the Analgesic Gap in Breakthrough Cancer Pain – A Drug Delivery Case Study

Source: Drug Delivery Technology Magazine, March 2008
By: Josef Bossart, PhD, and Taneli Jouhikainen, MD, PhD

Breakthrough cancer pain is a demanding challenge for patients, clinicians, and providers. Built on a background of constant pain, the breakthrough episode typically reaches peak intensity within seconds or at most a very few minutes and then resolves to background levels within an hour. It is as unpredictable in its occurrence as it is rapid in onset. While some breakthrough pain can be anticipated because it is associated with voluntary activity, in most cases, the pain arises without warning, making prophylaxis impractical.

Breakthrough pain has traditionally been treated in one of two manners. The first approach involves raising baseline pain treatment to a level where the breakthrough pain event is minimized by the higher dosage. The problem with this approach is that it means there is excess medication on board at all times, even when breakthrough events are absent. This results in an increase in the incidence and severity of side effects, such as sedation, dizziness, and constipation. The other choice for treatment is to take pain medication only when the breakthrough event arises. While this allows medication to be kept at a lower level sufficient to manage baseline pain, it requires the additional use of a breakthrough medication that can act very quickly, preferably for a period of time consistent with the duration of the pain episode. This type of pain management profile is usually associated with the use of intravenous opioids in the operating suite environment where a rapid onset of action and a shorter duration of action are desirable.

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