Jandhyala, R., Fullarton, J.R., & Bennett, M.I. (2013). Efficacy of rapid-onset oral fentanyl formulations vs. oral morphine for cancer-related breakthrough pain: A meta-analysis of comparative trials. Journal of Pain and Symptom Management, 46, 573–580.

STUDY PURPOSE: To evaluate the efficacy of oral fentanyl combinations for breakthrough cancer-related pain

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: PubMed

KEYWORDS: breakthrough cancer pain; incident pain; pain flare; morphine; fentanyl

INCLUSION CRITERIA: RCT

EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED: Not stated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not stated

• FINAL NUMBER STUDIES INCLUDED = 5
• SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Not provided
• KEY SAMPLE CHARACTERISTICS: Not provided

APPLICATIONS: Palliative care

The probability of superior relief of breakthrough pain by differences in pain intensity scores at 15- and 60-minute intervals was calculated for immediate-release morphine and fentanyl preparations, versus placebo and versus each other. There was a 61% probability that morphine would produce a better outcome than placebo. Corresponding results versus placebo for fentanyl buccal tablet (FBT) was 97%, for orally disintegrating tablet (ODT) was 72%, and for transmucosal oral fentanyl (OTF) tablet was 81%. The probability of superiority of fentanyl over morphine during the first 60 minutes was 68% for FBT, 57% for ODT, and 66% for OTF. Pain intensity differences were larger for fentanyl preparations than for morphine when compared to placebo.

Findings suggest that oral fentanyl preparations may provide better relief of breakthrough pain during the first 60 minutes than immediate-release oral morphine.

• Small number of studies
• Only one study directly compared fentanyl preparations to morphine.

Findings suggest that oral fentanyl preparations may be more effective for management of breakthrough pain than oral immediate-release morphine. It should be noted however, that the duration of effect with morphine could be longer because of differences in half-life. Onset, intensity, and duration of relief of breakthrough pain with various approaches need to be evaluated to determine the best approach for individual patients.