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Breakthrough Pain — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyBreakthrough PainSCE Medical Oncology

A 65-year-old man with metastatic gastric cancer and cancer-related pain is on a stable dose of oral morphine. He develops a new episode of breakthrough pain that comes on quickly (peak within 5 minutes) and lasts approximately 30 minutes. What is the most appropriate breakthrough pain medication?

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Correct answer: E — Transmucosal fentanyl (buccal or sublingual)

For rapid-onset breakthrough cancer pain (peak within minutes), transmucosal fentanyl (buccal, sublingual, nasal) provides the fastest onset of analgesia (5-15 minutes) compared with oral morphine IR (onset 20-30 minutes). This is particularly important for breakthrough pain episodes that peak quickly. The breakthrough dose should be titrated independently of the background opioid dose. Transmucosal fentanyl products are not interchangeable due to different bioavailability profiles.

Reference: NICE CG140 Opioids in palliative care; ESMO 2024 Pain Management Guidelines; BNF Fentanyl products