sábado, 28 de septiembre de 2013

Dolor por cáncer

Dosis única sublingual de fentanilo spray para dolor incidental por cáncer  
Single-dose fentanyl sublingual spray for breakthrough cancer pain.
Taylor DR.
Comprehensive Pain Care PC, Marietta, GA, USA.
Clin Pharmacol. 2013 Jul 24;5:131-41. doi: 10.2147/CPAA.S26649. Print 2013.
Abstract
Breakthrough cancer pain (BTCP) is defined as a transient exacerbation of pain that arises in patients with otherwise controlled persistent pain. BTCP typically has a rapid onset and relatively short duration, but it causes a significant amount of physical and psychological distress for patients. Several rapid-onset fentanyl formulations have been introduced in the USA to replace traditional oral opioids for the treatment of BTCP: a transmucosal lozenge, a sublingual orally disintegrating tablet, a buccal tablet, a buccal soluble film, a pectin nasal spray and, the newest formulation to enter the market, a sublingual spray. This article reviews the six rapid-onset formulations of fentanyl approved in the USA for the management of BTCP with emphasis on describing the published literature on fentanyl sublingual spray. The different fentanyl formulations vary in pharmacokinetic properties and ease of use, but all have a rapid onset and a relatively short duration of analgesia. Fentanyl sublingual spray has demonstrated absorption within 5 minutes of administration, with fentanyl plasma concentrations increasing over the first 30 minutes and remaining elevated for 60-90 minutes in pharmacokinetic studies in healthy subjects. Fentanyl sublingual spray shows linear dose proportionality, and changes in the temperature or acidity of the oral cavity do not alter its pharmacokinetic properties. In patients with BTCP, statistically significant pain relief is measurable at 5 minutes after administration of fentanyl sublingual spray, when compared with placebo, with significant pain relief lasting at least 60 minutes after administration. Adverse events are typical of opioid treatment and are considered mild to moderate in intensity. In summary, fentanyl sublingual spray provides rapid onset of analgesia and is a tolerable and effective treatment for BTCP.
KEYWORDS:
breakthrough pain, cancer, fentanyl, fentanyl sublingual spray, rapid-onset opioid, sublingual

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726301/pdf/cpaa-5-131.pdf  
Nuevos medicamentos para el dolor, pero los retos siguen siendo los usos       
New pain drugs in pipeline, but challenges to usage remain.
Brower V.
J Natl Cancer Inst. 2012 Apr 4;104(7):503-5. doi: 10.1093/jnci/djs199. Epub 2012 Mar 22.
Over the past two decades, pain control has become a front-burner issue among oncologists, but glaring problems in treating pain remain, a new survey shows.
Barriers limiting pain control include patients' reluctance to report pain and to take opioids, coupled with physicians' reluctance to prescribe them, as well as increasing regulatory barriers, according to a study in the Nov. 14 online issue of the Journal of Clinical Oncology
http://jnci.oxfordjournals.org/content/104/7/503.full.pdf 

 
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Anestesiología y Medicina del Dolor
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