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Reviewer: Ryan P. Smith, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 5 de diciembre del 2003
Authors: Farrar JT, Cleary J, Rauck R, Busch M, Nordbrock E
Source: JNCI, Vol 90(8), 1998, 611-616
This is an important report of a newer type of short-acting narcotic designed to treat episodes of breakthrough pain. The main advantage, as pointed out by the authors, is that OFTC has a rapid onset, hence relieving cancer patients' breakthrough pain quicker. This study indicates that OFTC is useful in this regard, as compared to placebo controls. This advantage started at the 15 minute self-report by the patients, which would indicate a more rapid, efficacious onset. This relief also lasted the entire 60 minutes that the patients were required to self-report. There was also little toxicity involved in the use of OFTC. Although the OFTCs were more efficacious, there was an obvious placebo effect, as noted by the fact that patients used rescue medication in only 34% of the episodes.
What is perhaps most impressive about the study is the amount of breakthrough pain episodes that the patients reported. There were hundreds of episodes in these 93 patients, indicating that pain management is of utmost importance in cancer patients. Hopefully OFTC can play a role in the treatment of breakthrough pain. Although it was efficacious when compared to placebo in this study, the true test of its usefulness would lie in a randomized study comparing it to other medications designed to treat breakthrough pain. This is exemplified by the fact that, out of the original 130 patients that started in the open label portion of the study, only 74 patients chose to continue OFTC as their primary treatment of breakthrough pain. Obviously, pain management must be individualized, but OFTC's rapid onset and safe toxicity profile should at least be considered in patients for the treatment of breakthrough pain
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