Stopping Breakthrough Pain With Fast-Acting Drugs

While some chronic pain sufferers can manage occasional breakthrough episodes without extra medication, many will need fast-acting pain meds to cope with the kind of stabbing pain that can take your breath away. And doctors recognize that breakthrough pain must be specifically targeted, above and beyond treatments that control the background chronic pain. In some cases, adjustment of basic-treatment pain drugs can solve the problem. In others, new drugs may need to be introduced.

The problem with traditional opioid drugs is that although they work very quickly when taken intravenously (as they are by some cancer patients, for example, who can increase an IV dose if breakthrough pain occurs), the same drugs can take a long time to kick in if taken by mouth—longer than a breakthrough pain episode might last.

To address this problem, researchers have developed rapid-delivery drugs, including the so-called "narcotic lollipop," Actiq (oral transmucosal fentanyl citrate). Absorbed quickly through the mouth, Actiq can begin relieving pain within five minutes and lasts at least an hour.

Off-label use of the narcotic "lollipop"
There is some controversy surrounding Actiq. Approved in 1998 only for cancer patients already being treated with opioids, it has been widely prescribed "off-label"—for unapproved uses—to noncancer patients. One estimate put the percentage of off-label prescriptions at 80%.

Cephalon, the makers of Actiq, have now released another drug, Fentora, which also contains fentanyl and is approved for the same uses. Absorption is better and faster than Actiq; it doesn't use a lollipop, but a patented form of effervescence.

Andrea Cooper, 52, of Phoenix, Md., who has fibromyalgia and spinal degeneration, says she couldn't live without breakthrough-pain medication. "The doctors call it a rescue dose, and it truly is a rescue dose for me," says Cooper, who initially used Actiq but has now switched to Fentora.

Cooper is constantly vigilant for signs of breakthrough pain; she realizes that if it takes hold, calming her pain generally becomes more difficult. "The whole thing about pain medication and pain management is to keep it at a manageable level all the time, and not allow it to ever spike. It becomes much harder to get it down, like a kid who's eaten too much chocolate. It's hard to tie him down."