Mazzola, R., Ricchetti, F., Fiorentino, A., Giaj-Levra, N., Fersino, S., Tebano, U., . . . Alongi, F. (2016). Fentanyl pectin nasal spray for painful mucositis in head and neck cancers during intensity-modulated radiation therapy with or without chemotherapy. Clinical and Translational Oncology, 19, 593–598.

To evaluate the effect and toleration of transmucosal opioid for painful mucositis affecting swallowing.

Retrospective medical chart review was done for data collection for individuals who had opioid maintenance and received fentanyl pectin nasal spray for incidental mucositis pain. Results in patients were compared at different time points when they did and did not use fentanyl pectin nasal spray for incidental breakthrough pain.

• N: 40   
• AGE: Mean age = 64.08 years, range = 36-80
• MALES: 70%  
• FEMALES: 30%
• CURRENT TREATMENT: Radiation, combination radiation and chemotherapy
• KEY DISEASE CHARACTERISTICS: Head and neck cancer, orophyarynx most common site

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Spain

PHASE OF CARE: Active anti-tumor treatment

Retrospective observational

• Oral intake
• Prevalence of breakthrough pain
• Numeric rating scale for pain intensity

After implementation of transmucosal opioid for incidental pain, oral intake improved (p = 0.000). With use of fentanyl pectin nasal spray, intensity of breakthrough pain episodes went from 5.73 (SD = 1.54) to 2.25 (SD = 2.45).

Transmucosal opioids may be helpful in managing incidental pain associated with mucositis, and may facilitate oral nutritional intake.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described

Due to rapid onset, transmucosal opioid use for incidental pain that interferes with swallowing and oral intake in patients with head and neck cancer may be of benefit. Further well-designed research in this area is warranted.