Letters Controlling pain in cancer

Breakthrough cancer pain

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2689 (Published 25 November 2008) Cite this as: BMJ 2008;337:a2689
  1. Andrew N Davies, consultant in palliative medicine1,
  2. Andrew Dickman, senior clinical pharmacist2,
  3. Colette Reid, consultant in palliative medicine3,
  4. Anna-Marie Stevens, senior clinical nurse specialist in palliative care1,
  5. Giovambattista Zeppetella, medical director4
  1. 1Royal Marsden NHS Foundation Trust, Sutton SM2 5PT
  2. 2Marie Curie Palliative Care Institute, Liverpool
  3. 3Gloucestershire Hospitals NHS Trust
  4. 4St Clare Hospice, Hastingwood
  1. andrew.davies{at}rmh.nhs.uk

    The SIGN guidelines say that both morphine sulphate immediate release and oral transmucosal fentanyl citrate are effective in reducing breakthrough cancer pain.1 But little evidence (and certainly not grade B evidence) supports the unlicensed use of oral morphine. Its pharmacodynamic profile also does not mirror the temporal characteristics of most episodes of breakthrough cancer pain. These are acute in onset, short in duration, and …

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