New nasal spray for breakthrough cancer pain is approved for use in Wales
Tuesday 8 June
The All Wales Medicines Strategy Group (AWMSG) has approved Instanyl™, (fentanyl) for use in Wales to help cancer patients manage episodes of breakthrough pain.
Instanyl is a new intranasal way of delivering fentanyl. There are of a variety of fentanyl products in different formulations being used by myeloma patients for breakthrough pain relief. These include fentanyl as a patch, lollipop, tablet, and effervescent tablet.
Eric Low, Myeloma UK Chief Executive, welcomed the decision by the AWMSG:
“Breakthrough pain is a very common complication in myeloma and it is vital that patients have access to fast-acting, convenient and meaningful relief. The intranasal formulation of Instanyl has the potential to offer patients a convenient alternative means of administration, which may be particularly useful for patients with dry or painful mouths for whom current formulations of fentanyl are less convenient.”
Q & A
What is breakthrough cancer pain?
Breakthrough cancer pain is when a patient experiences additional, sudden pain in spite of ongoing treatment to manage the chronic or background pain associated with his or her cancer.
Many myeloma patients experience regular bone pain and are offered medication to reduce and manage the pain. It can usually be fairly well-managed with the appropriate treatment and support.
Breakthrough pain involves short and very intense bursts of pain and can be much harder to treat effectively than ongoing background pain. Although it can vary between patients, those who experience breakthrough pain often have several episodes a day, lasting 30 minutes on average.
The causes of breakthrough pain may be due to the effects of myeloma or its treatment, or brought on by activities such as walking or taking a shower. It is important to manage breakthrough pain well as it can cause significant anxiety as well as difficulty sleeping or going about daily activities.
Increasing the background pain treatment is rarely effective at treating breakthrough pain. Instead, breakthrough pain requires a faster mechanism of action and shorter duration of effect to match the pain episode experienced.
What is Instanyl™ (fentanyl)?
Fentanyl is a fast-acting pain relief product and one of the main treatments used for breakthrough cancer pain. It comes in a variety of formulations, such as lollipops, patches and tablets.
More fentanyl products, designed to achieve pain relief as quickly and effectively as possible are being developed. Instanyl, developed by Nycomed, is the first intranasal spray formulation of fentanyl produced to date.
In the trials, patients reported positive benefits from using Instanyl in terms of achieving meaningful pain relief and ease of administration.
What does the AWMSG recommendation say?
The AWMSG reviewed the evidence for Instanyl. It concluded that it was both clinically-effective and cost-effective for the NHS in Wales.
The Welsh Minister for Health and Social Services today ratified the decision by the AWMSG. The ratification means that Health Boards in Wales are required to implement the guidance at a local level within three months.
You can download the full AWMSG guidance here
Is Instanyl available to myeloma patients elsewhere in the UK?
Instanyl was approved by the Scottish Medicines Consortium in early 2010 and should be readily available to myeloma patients in Scotland whose doctor has prescribed it for them.
Instanyl may not yet be routinely available to patients living in England, or Northern Ireland. However, if you and your doctor decide Instanyl is the appropriate treatment for you, your doctor can make an individual funding request for Instanyl to the local Primary Care Trust or Health Board.
Where can I find out more?
Myeloma UK is currently producing information on breakthrough pain and how it can be managed. It will be available to download from the Patient Resources page on the website or by requesting a paper copy from Myeloma UK.
To order your copy when it is available or for further information please contact Ellen Watters, Myeloma Information Nurse Specialist, on 0800 980 3332 or by emailing ellenw@myeloma.org.uk
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