Ketterer explained certain important aspects of our article (1) in an even more poignant and lucid way. He adds that the definition of breakthrough pain is often wrongly used in vernacular language. As early as in 2002, Mercadante et al discussed in a consensus paper from the European Association for Palliative Care that the English term “breakthrough pain” is used inconsistently and suggested using the term “episodic pain,” which, however, has not become widely accepted and adopted (2). Furthermore, they said that translation into different languages—as into German with the word “Durchbruchschmerz” [breakthrough pain]—only served to increase the semantic confusion.
With regard to predictable episodes of pain, such as the above-mentioned incident pain, we agree with our colleague’s explanations. Prevention, whose first step is surely providing the patient with information, is always the best therapeutic option. Where this is not enough, a differentiated use of medication options available should be selected, including that of non-fentanyl-preparations.
We actually did discuss the risk of addiction in our article (1). The scarce evidence should not be misinterpreted as a low risk. We would assess the topic of fitness to drive in a similar way. Even though currently no scientific studies of the topic exist, the conclusion should not be that the substances under discussion give no cause for concern in this respect.
We therefore also reach the conclusion that the use of rapid-onset fentanyl requires a strict and restricted indication and—as we said in our review article—needs to be handled responsibly by both doctors and patients (1).
Dr. med. univ. et scient. med. Helmar Bornemann-Cimenti
Dr. med. univ. Mischa Wejbora
Mag. rer. nat. Dr. scient. med. Istvan S. Szilagyi
Prof. Dr. med. univ. Andreas Sandner-Kiesling
Universitätsklinik für Anästhesiologie und Intensivmedizin
Medizinische Universität Graz
Conflict of interest statement
Professor Sandner-Kiesling has had conference attendance fees and travel expenses reimbursed by Pfizer, Mundipharma, Cephalon, Grünenthal, and Fresenius. He has received lecture fees from Cephalon and Grünenthal.
The other authors declare that no conflict of interest exists.
|1.||Bornemann-Cimenti H, Wejbora M, Szilagyi IS, Sandner-Kiesling A: Fentanyl for the treatment of tumor-related breakthrough pain. Dtsch Arztebl Int 2013; 110(16): 271–7 VOLLTEXT|
|2.||Mercadante S, Radbruch L, Caraceni A, et al.: Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer 2002; 94: 832–9 CrossRef MEDLINE|