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Using Fentanyl for Breakthrough Pain

Breakthrough pain is an intense, sudden burst of pain that "breaks through" regularly scheduled, around-the-clock pain treatment. Short-acting fentanyl products are approved to treat breakthrough pain in people with cancer who are already taking regularly scheduled narcotic pain medication to treat their persistent cancer pain.
The fentanyl products used to treat breakthrough pain come in several different forms, including:


All of these products are absorbed into the bloodstream through mucosal linings, either of the mouth or nose. Fentanyl lozenges, tablets, and film are made to dissolve inside the mouth. They should not be swallowed whole. Fentanyl sublingual spray is sprayed underneath the tongue. Fentanyl nasal spray is sprayed into one or both nostrils.
Fentanyl is a strong opioid medication. It should not be used to treat short-term pain (sometimes called acute pain), including pain after surgery or other medical or dental procedures, or headache or migraine pain.
All fentanyl products are only approved for use in people who have been taking other opioid pain medications and are tolerant to their effects. In general, people are considered opioid tolerant if they have been taking at least 60 mg of morphine, 30 mg of oxycodone, 8 mg of hydromorphone, or an equivalent dose of another opioid every day for at least a week.
Fentanyl is a Schedule II controlled substance because it has a high potential for abuse. Schedule II medications are considered to have the highest abuse potential of all prescription medicines. There are strict laws and regulations for prescribing and obtaining these medications.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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