Rogriguez, D., Urrutia, G., Escobar, Y., Moya, J., & Murillo, M. (2015). Efficacy and safety of oral or nasal fentanyl for treatment of breakthrough pain in cancer patients: A systematic review. Journal of Pain and Palliative Care Pharmacotherapy, 29, 228–246.

STUDY PURPOSE: To evaluate different oral or transmucosal fentanyl formulations for breatkthrough pain

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, Cochrane Collaboration through June 2012

INCLUSION CRITERIA: Not specified

EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED: 414

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Risk of bias assessment based on Cochrane, approach GRADE system classification. Lack of detail in some studies did not allow for risk of bias determination.

FINAL NUMBER STUDIES INCLUDED: 11

TOTAL PATIENTS INCLUDED IN REVIEW: 1,121

SAMPLE RANGE ACROSS STUDIES: 25 to 139

PHASE OF CARE: Late effects and survivorship

Fentanyl buccal tablets: 2 studies
Oral transmucosal fentanyl citrate: 5 studies
Sublingual fentanyl citrate tablets: 2 studies
Fentanyl buccal soluble film: 1 study
Intranasal fentanyl spray: 2 studies
Fentanyl pectin nasal spray: 4 studies
All oral and intranasal formulations seem to be effective treatment for breakthrough episodes and it is not possible to conclude that any formulation is superior to others. There is limited information regarding long-term safety. Transmucosal opioids appear to be superior to immediate-release morphine.

Transmucosal opioids are effective for managing breakthrough pain and appear to be superior to immediate-release opioid.

• Limited number of studies included
• Studies are rather old and many additional studies have been published since the end date of this search

Transmucosal opioids are effective for management of breakthrough pain. Nurses can advocate for use of these formulations which appear to be superior to immediate-release morphine. Transmucosal opioids have more rapid onset, which is important for breakthrough pain. There are varied methods for establishing dosages to be used and further work to identify most effective methods for dose determination would be helpful.