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Erschienen in: Der Anaesthesist 7/2011

01.07.2011 | Palliativmedizin

Tumordurchbruchschmerz

Indikation für schnell wirksame Opioide

verfasst von: Dr. J. Keßler, H.J. Bardenheuer

Erschienen in: Die Anaesthesiologie | Ausgabe 7/2011

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Zusammenfassung

Die Pharmakotherapie des Tumorschmerzes verfolgt zwei wesentliche Ziele: die adäquate Basisanalgesie mithilfe retardierter Opioiddauermedikation und die effektive Behandlung des Tumordurchbruchschmerzes mithilfe nichtretardierter, schnell wirksamer Opioide. Der Durchbruchschmerz ist durch einen plötzlich einsetzenden, schnellen Anstieg des Schmerzniveaus charakterisiert und sollte mit entsprechend schnell wirksamen Opioiden behandelt werden. Die pharmakologischen Eigenschaften der bisher verfügbaren und regelmäßig eingesetzten nichtretardierten Opioide entsprechen in der oralen Galenik nicht immer den aus der Definition des Tumordurchbruchschmerzes hervorgehenden Anforderungen. Als Alternative zu diesen Substanzen stehen mittlerweile 5 verschiedene schnell wirksame Fentanylformulierungen zur transmukosalen Anwendung zur Verfügung.
Literatur
1.
Zurück zum Zitat Hanks GW, Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593PubMedCrossRef Hanks GW, Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593PubMedCrossRef
2.
Zurück zum Zitat Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41(3):273–281PubMedCrossRef Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41(3):273–281PubMedCrossRef
3.
Zurück zum Zitat Svendsen KB, Andersen S, Arnason S et al (2005) Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 9(2):195–206PubMedCrossRef Svendsen KB, Andersen S, Arnason S et al (2005) Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 9(2):195–206PubMedCrossRef
4.
Zurück zum Zitat Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain 82(3):263–274PubMedCrossRef Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain 82(3):263–274PubMedCrossRef
5.
Zurück zum Zitat Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433PubMedCrossRef Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433PubMedCrossRef
6.
Zurück zum Zitat Fortner BV, Demarco G, Irving G et al (2003) Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manage 25(1):9–18PubMedCrossRef Fortner BV, Demarco G, Irving G et al (2003) Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manage 25(1):9–18PubMedCrossRef
7.
Zurück zum Zitat Slatkin NE, Xie F, Messina J, Segal TJ (2007) Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. J Support Oncol 5(7):327–334PubMed Slatkin NE, Xie F, Messina J, Segal TJ (2007) Fentanyl buccal tablet for relief of breakthrough pain in opioid-tolerant patients with cancer-related chronic pain. J Support Oncol 5(7):327–334PubMed
8.
Zurück zum Zitat Labroo RB, Paine MF, Thummel KE, Kharasch ED (1997) Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implications for interindividual variability in disposition, efficacy, and drug interactions. Drug Metab Dispos 25(9):1072–1080PubMed Labroo RB, Paine MF, Thummel KE, Kharasch ED (1997) Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implications for interindividual variability in disposition, efficacy, and drug interactions. Drug Metab Dispos 25(9):1072–1080PubMed
9.
Zurück zum Zitat Cawley MM, Benson LM (2005) Current trends in managing oral mucositis. Clin J Oncol Nurs 9(5):584–592PubMedCrossRef Cawley MM, Benson LM (2005) Current trends in managing oral mucositis. Clin J Oncol Nurs 9(5):584–592PubMedCrossRef
10.
Zurück zum Zitat Payne R, Coluzzi P, Hart L et al (2001) Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. J Pain Symptom Manage 22(1):575–583PubMedCrossRef Payne R, Coluzzi P, Hart L et al (2001) Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. J Pain Symptom Manage 22(1):575–583PubMedCrossRef
11.
Zurück zum Zitat Jobbins J, Bagg J, Finlay IG et al (1992) Oral and dental disease in terminally ill cancer patients. BMJ 304(6842):1612PubMedCrossRef Jobbins J, Bagg J, Finlay IG et al (1992) Oral and dental disease in terminally ill cancer patients. BMJ 304(6842):1612PubMedCrossRef
12.
Zurück zum Zitat Streisand JB, Varvel JR, Stanski DR et al (1991) Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75(2):223–229PubMedCrossRef Streisand JB, Varvel JR, Stanski DR et al (1991) Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75(2):223–229PubMedCrossRef
13.
14.
Zurück zum Zitat Lichtor JL, Sevarino FB, Joshi GP et al (1999) The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg 89(3):732–738PubMed Lichtor JL, Sevarino FB, Joshi GP et al (1999) The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg 89(3):732–738PubMed
15.
Zurück zum Zitat Coluzzi PH, Schwartzberg L, Conroy JD et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91(1–2):123–130 Coluzzi PH, Schwartzberg L, Conroy JD et al (2001) Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91(1–2):123–130
16.
Zurück zum Zitat Zeppetella G (2008) Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 35(5):563–567PubMedCrossRef Zeppetella G (2008) Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 35(5):563–567PubMedCrossRef
17.
Zurück zum Zitat Ashburn MA, Lind GH, Gillie MH et al (1993) Oral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain. Anesth Analg 76(2):377–381PubMed Ashburn MA, Lind GH, Gillie MH et al (1993) Oral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain. Anesth Analg 76(2):377–381PubMed
18.
Zurück zum Zitat Sharar SR, Bratton SL, Carrougher GJ et al (1998) A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 19(6):516–521PubMedCrossRef Sharar SR, Bratton SL, Carrougher GJ et al (1998) A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 19(6):516–521PubMedCrossRef
19.
Zurück zum Zitat Sharar SR, Carrougher GJ, Selzer K et al (2002) A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabil 23(1):27–31PubMedCrossRef Sharar SR, Carrougher GJ, Selzer K et al (2002) A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabil 23(1):27–31PubMedCrossRef
20.
Zurück zum Zitat Mahar PJ, Rana JA, Kennedy CS, Christopher NC (2007) A randomized clinical trial of oral transmucosal fentanyl citrate versus intravenous morphine sulfate for initial control of pain in children with extremity injuries. Pediatr Emerg Care 23(8):544–548PubMedCrossRef Mahar PJ, Rana JA, Kennedy CS, Christopher NC (2007) A randomized clinical trial of oral transmucosal fentanyl citrate versus intravenous morphine sulfate for initial control of pain in children with extremity injuries. Pediatr Emerg Care 23(8):544–548PubMedCrossRef
21.
Zurück zum Zitat Lennernas B, Hedner T, Holmberg M et al (2005) Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: a new approach to treatment of incident pain. Br J Clin Pharmacol 59(2):249–253PubMedCrossRef Lennernas B, Hedner T, Holmberg M et al (2005) Pharmacokinetics and tolerability of different doses of fentanyl following sublingual administration of a rapidly dissolving tablet to cancer patients: a new approach to treatment of incident pain. Br J Clin Pharmacol 59(2):249–253PubMedCrossRef
22.
Zurück zum Zitat Rauck RL, Tark M, Reyes E et al (2009) Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 25(12):2877–2885PubMedCrossRef Rauck RL, Tark M, Reyes E et al (2009) Efficacy and long-term tolerability of sublingual fentanyl orally disintegrating tablet in the treatment of breakthrough cancer pain. Curr Med Res Opin 25(12):2877–2885PubMedCrossRef
23.
Zurück zum Zitat Darwish M, Tempero K, Kirby M, Thompson J (2006) Relative bioavailability of the fentanyl effervescent buccal tablet (FEBT) 1,080 pg versus oral transmucosal fentanyl citrate 1,600 pg and dose proportionality of FEBT 270 to 1,300 microg: a single-dose, randomized, open-label, three-period study in healthy adult volunteers. Clin Ther 28(5):715–724PubMedCrossRef Darwish M, Tempero K, Kirby M, Thompson J (2006) Relative bioavailability of the fentanyl effervescent buccal tablet (FEBT) 1,080 pg versus oral transmucosal fentanyl citrate 1,600 pg and dose proportionality of FEBT 270 to 1,300 microg: a single-dose, randomized, open-label, three-period study in healthy adult volunteers. Clin Ther 28(5):715–724PubMedCrossRef
24.
Zurück zum Zitat Dale O, Hjortkjaer R, Kharasch ED (2002) Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand 46(7):759–770PubMedCrossRef Dale O, Hjortkjaer R, Kharasch ED (2002) Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand 46(7):759–770PubMedCrossRef
25.
Zurück zum Zitat Shelley K, Paech MJ (2008) The clinical applications of intranasal opioids. Curr Drug Deliv 5(1):55–58PubMedCrossRef Shelley K, Paech MJ (2008) The clinical applications of intranasal opioids. Curr Drug Deliv 5(1):55–58PubMedCrossRef
26.
Zurück zum Zitat Foster D, Upton R, Christrup L, Popper L (2008) Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Ann Pharmacother 42(10):1380–1387PubMedCrossRef Foster D, Upton R, Christrup L, Popper L (2008) Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Ann Pharmacother 42(10):1380–1387PubMedCrossRef
27.
Zurück zum Zitat Coda BA, Rudy AC, Archer SM, Wermeling DP (2003) Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. Anesth Analg 97(1):117–123, table of contentsPubMedCrossRef Coda BA, Rudy AC, Archer SM, Wermeling DP (2003) Pharmacokinetics and bioavailability of single-dose intranasal hydromorphone hydrochloride in healthy volunteers. Anesth Analg 97(1):117–123, table of contentsPubMedCrossRef
28.
Zurück zum Zitat Kress HG, Oronska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31(6):1177–1191PubMedCrossRef Kress HG, Oronska A, Kaczmarek Z et al (2009) Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period. Clin Ther 31(6):1177–1191PubMedCrossRef
29.
Zurück zum Zitat Mercadante S, Radbruch L, Davies A et al (2009) A comparison of intranasal fentanyl spray with oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: an open-label, randomised, crossover trial. Curr Med Res Opin 25(11):2805–2815PubMed Mercadante S, Radbruch L, Davies A et al (2009) A comparison of intranasal fentanyl spray with oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: an open-label, randomised, crossover trial. Curr Med Res Opin 25(11):2805–2815PubMed
30.
Zurück zum Zitat Kaasa S, Moksnes K, Nolte T et al (2010) Pharmacokinetics of intranasal fentanyl spray in patients with cancer and breakthrough pain. J Opioid Manag 6(1):17–26PubMed Kaasa S, Moksnes K, Nolte T et al (2010) Pharmacokinetics of intranasal fentanyl spray in patients with cancer and breakthrough pain. J Opioid Manag 6(1):17–26PubMed
31.
Zurück zum Zitat Portenoy RK, Burton AW, Gabrail N, Taylor D (2010) A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain 151(3):617–624PubMedCrossRef Portenoy RK, Burton AW, Gabrail N, Taylor D (2010) A multicenter, placebo-controlled, double-blind, multiple-crossover study of Fentanyl Pectin Nasal Spray (FPNS) in the treatment of breakthrough cancer pain. Pain 151(3):617–624PubMedCrossRef
32.
Zurück zum Zitat Fisher A, Watling M, Smith A, Knight A (2010) Pharmacokinetics and relative bioavailability of fentanyl pectin nasal spray 100–800 microg in healthy volunteers. Int J Clin Pharmacol Ther 48(12):860–867PubMed Fisher A, Watling M, Smith A, Knight A (2010) Pharmacokinetics and relative bioavailability of fentanyl pectin nasal spray 100–800 microg in healthy volunteers. Int J Clin Pharmacol Ther 48(12):860–867PubMed
33.
Zurück zum Zitat Portenoy RK, Raffaeli W, Torres LM et al (2010) Long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray for breakthrough cancer pain in opioid-tolerant patients. J Opioid Manag 6(5):319–328PubMed Portenoy RK, Raffaeli W, Torres LM et al (2010) Long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray for breakthrough cancer pain in opioid-tolerant patients. J Opioid Manag 6(5):319–328PubMed
Metadaten
Titel
Tumordurchbruchschmerz
Indikation für schnell wirksame Opioide
verfasst von
Dr. J. Keßler
H.J. Bardenheuer
Publikationsdatum
01.07.2011
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 7/2011
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-011-1868-1

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