Breakthrough pain is a common problem for patients with chronic pain, such as those suffering from RSD, autoimmune disease and cancer. While oral formulations of pain medications are often given, these drugs can take up to 30 minutes to take effect and then a further 1 to 2 hours to reach maximum effects. One method of drug delivery that has been found to be both fast and effective is intranasal sprays.

In a recent study conducted at Tufts University, 20 patients with chronic pain and at least 2 spontaneous episodes of breakthrough pain (BTP) self-administered up to 5 doses of intranasal ketamine or placebo at the onset of a spontaneous BTP episode. Patients reported significantly lower BTP intensity following intranasal ketamine than after placebo with pain relief within 10 minutes of dosing and lasting for up to 60 minutes. No patients in the ketamine group required their usual rescue medication to treat the BTP episode, while 7 out of 20 in the placebo group did. Intranasal ketamine was well tolerated with no serious adverse events. The data suggested that intranasal administration of ketamine provides rapid, safe and effective relief for BTP.*

A phase 3 trial conducted at St. Olavs Hospital  and Institute of Cancer Research and Molecular Medicine in Trondheim, Norway, studied patients who were experiencing 3 to 4 episodes of breakthrough pain per week and were receiving 60 to 500mg of oral morphine per day or 20 to 200 mcg/hour of transdermal fentanyl. Each patient was treated with a combination of intranasal fentanyl in various strengths and intranasal placebos. The trial found that patients treated with intranasal fentanyl required significantly less rescue medication to manage their breakthrough pain compared with placebo-treated patients. The authors of the trial concluded that "All doses were efficacious and well tolerated for patients regardless of their background opiate use."** They suggested that the analgesic profile of intransal fentanyl together with its fast onset of action make it a particularly valuable addition to the management of breakthrough cancer pain.

These results suggest that intranasal administration of other pain meds hold promise as well.

* www.ncbi.nlm.gov/pubmed/15109503

** www.plsgroup.com/dg/229E3A.htm