pectins and Pain

Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated.. Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients.. The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.

Topics: Administration, Intranasal; Administration, Oral; Analgesics, Opioid; Drug Delivery Systems; Fentanyl; Humans; Nasal Sprays; Neoplasms; Pain; Pectins

Fentanyl pectin nasal spray (PecFent®) uses a novel pectin-based delivery system that turns from an aqueous solution into a gel when applied to mucosal surfaces. Fentanyl is absorbed in a controlled manner from the pectin gel formed in the nasal cavity, and has a rapid onset of pain relief and duration of action that matches the time course of a typical episode of breakthrough pain in cancer (BTPc). Relative to administration as oral transmucosal fentanyl, fentanyl administered as fentanyl pectin nasal spray is more rapidly absorbed, reaches higher maximum plasma concentrations and has greater bioavailability. In the treatment of BTPc in two randomized, double-blind, crossover trials in opioid-tolerant adults, fentanyl pectin nasal spray (100-800 μg titrated doses) was significantly more effective than placebo in reducing pain intensity and provided a significantly faster onset of pain relief than oral immediate-release morphine. During long-term treatment of BTPc episodes, fentanyl pectin nasal spray consistently provided effective pain relief in an open-label, 16-week trial. Most patients were satisfied or very satisfied with the ease of use and convenience of the nasal spray. Fentanyl pectin nasal spray 100-800 μg was generally well tolerated and was not associated with nasal tolerability problems.

Topics: Analgesics, Opioid; Drug Tolerance; Fentanyl; Humans; Nasal Sprays; Neoplasms; Pain; Pectins

A prospective, double-blind study compared the effectiveness of sucralfate suspension with diphenhydramine syrup plus kaolin-pectin in reducing severity and pain of radiation-induced oropharyngeal mucositis. Fourteen patients who received at least 4600 cGy to the oral cavity used one of the mouth rinses four times a day, beginning at 1600 cGy. Data were collected on daily perceived pain and helpfulness of mouth rinse, weekly mucositis grade, weight change, and interruption of therapy. Analysis of data revealed no statistically significant differences between the two groups in any parameter. A retrospective review of 15 patients who had received at least 4600 cGy radiation to the oropharynx but had not used a daily mouth-coating rinse, was compared with the study group. Comparison of the two groups suggested that consistent daily oral hygiene and use of a mouth-coating agent will result in less pain and may reduce weight loss and interruption of radiation because of severe mucositis.

Topics: Adult; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Cobalt; Diphenhydramine; Double-Blind Method; Humans; Kaolin; Mouth Mucosa; Mouth Neoplasms; Mouthwashes; Pain; Palliative Care; Pectins; Prospective Studies; Radioisotope Teletherapy; Retrospective Studies; Stomatitis; Sucralfate

Topics: Animals; Carrageenan; Chromatography, Gas; Edema; Humans; Magnetic Resonance Spectroscopy; Mass Spectrometry; Mice; Opuntia; Pain; Pectins; Polysaccharides; Rats; Spectroscopy, Fourier Transform Infrared; Xylenes

Fentanyl pectin nasal spray is a novel intranasal formulation for the management of breakthrough cancer pain in patients taking and tolerant to opioids for persistent cancer pain. The pectin-based delivery modulates the product's transmucosal absorption. Nasal delivery allows fentanyl pectin nasal spray to achieve a greater maximum plasma concentration than oral transmucosal fentanyl products and at a much faster rate. Compared with intranasal fentanyl compounded with aqueous solutions, the pectin-based system decreases the maximum plasma concentration and prolongs exposure to more closely match the time course of a typical breakthrough cancer pain episode. Throughout all phases of clinical studies, it was shown to be safe and effective in doses between 100 and 800 µg per breakthrough pain episode. Fentanyl pectin nasal spray is the only proprietary intranasal fentanyl formulation in the USA and one of two in Europe. Owing to the medication's delivery system, the pharmacokinetics and subsequent dosing are unique to this product and should not be interchanged with any other proprietary or compounded fentanyl product.

Topics: Administration, Intranasal; Analgesics, Opioid; Dose-Response Relationship, Drug; Drug Carriers; Fentanyl; Humans; Nasal Sprays; Neoplasms; Pain; Pectins; Randomized Controlled Trials as Topic

Topics: Analgesia; Carboxymethylcellulose Sodium; Catheters, Indwelling; Drug Combinations; Gelatin; Humans; Injections, Epidural; Methylcellulose; Morphine; Neoplasms; Pain; Pectins; Polyenes; Tissue Adhesives

Topics: Anesthesia, Dental; Benzocaine; Dentistry; Methylcellulose; Mouth Diseases; Occlusive Dressings; Ointments; Pain; Pectins; Polyethylenes; Tooth Extraction; Wound Healing