Oncology

Tumours: 44% of patients live with pain, fentanyl spray becomes safer

The device with an electronic safety and dose control system that reduces the risk of accidental overdose and abuse is available in Italia

by Health Review

27 February 2026

Medical drip with patient in the hospital blurred background

3' min read

Translated by AI

Versione italiana

Key points

Opioid use for pain
Grief is not only about the end of life
The peculiarity of nasal spray

3' min read

Translated by AI

Versione italiana

Almost one in two cancer patients (44%) live with pain that may occur at all stages of the disease and persist even after recovery, significantly affecting quality of life and adherence to cancer therapies. In addition to chronic pain, about 70% of patients are affected by so-called intense episodic pain: sudden, short-lasting, but very intense crises that overlap with the basic pain even when the latter is well controlled, and that require timely and targeted interventions.

The use of opiates for pain

'Opioids are first-line drugs in the treatment of cancer pain because of their high analgesic efficacy: they act on mu opioid receptors by inhibiting the transmission of pain stimuli,' explains Diego Fornasari, Professor of Pharmacology at the University of Milan and President of AISD (Italian Association for the Study of Pain). Fentanyl has an analgesic potency about 100 times higher than morphine and is effective and safe in the different types of pain associated with cancer.

Thanks to its liposolubility, which allows it to easily cross cell membranes, it can be administered transdermally or transmucosal, including nasally, which is particularly indicated in intense episodic pain. Device innovation now makes it possible to further enhance safety levels'.

During the event 'Oncological pain management and opioids: technology and innovation for patient safety', promoted by the Gentili Institute in Milan, an electronic safety system integrated into the nasal spray device was presented, equipped with a digital dose counter and a blocking mechanism between administrations that minimise the risk of accidental overdose, abuse or misuse.

Grief is not only about the end of life

Pain crises are often unpredictable, and may be triggered by a movement, a cough or medical procedures such as changing a dressing: brief but intense episodes that burst into the patient's life and undermine balance and serenity.

"Let's dispel the myth that pain only concerns the end of life: 40% of cancers are diagnosed precisely because they start with pain, which continues to occur even in 30% of long-term survivors - says Arturo Cuomo, director S.C. Anesthesia, Resuscitation and Analgesic Therapy, Istituto Nazionale Tumori - Irccs Fondazione Pascale in Naples -. Intense episodic pain impacts on the quality of life as much as, if not more than, continuous pain and requires a dedicated approach. The concept of simultaneous care is central: treating the symptoms while treating the tumour, as indicated in the National Cancer Plan. Early and appropriate care means reducing suffering, improving adherence to cancer treatment and contributing to survival'.

Fentanyl belongs to the so-called 'strong opioids' of the 'third rung' of the WHO analgesic ladder and is recommended by national and international guidelines as the first option in the treatment of moderate-to-severe cancer pain. Aiom guidelines indicate its use by the transmucosal route in the control of Breakthrough Cancer Pain.

The peculiarity of nasal spray

"Intense episodic pain, even if short-lived, can be devastating," stresses Vittorio Guardamagna, director of the IEO's Palliative Care and Pain Therapy Division. The peculiarity of the nasal spray is that it allows Fentanyl to enter the circulation rapidly, with a speed of action comparable to intravenous administration, and is also indicated in patients with swallowing difficulties. A further advantage is that it is metabolised quickly and tends not to accumulate in the circulation. Today, speed can be combined with an additional level of safety thanks to the new device, which prevents the patient from close dispensing and reduces the risk of improper use outside the medical sphere. It is a concrete example of how technology can support clinical practice and patient safety'.

In a context where the debate on opiates is often marked by fears and oversimplifications, the experts reiterated the need to distinguish between therapeutic use and misuse, in order to strengthen confidence in their use in the clinical setting, where prescription and monitoring are carried out according to strict criteria.

"In the cancer patient the objective is to alleviate real and disabling suffering," says Franco Marinangeli, Professor of Anaesthesia and Resuscitation at the University of L'Aquila. "Law 38 sanctioned the right to pain treatment: not using effective drugs when indicated is unethical. Opiates remain a fundamental therapeutic tool. The challenge is to combine efficacy and safety through appropriate use tailored to the patient's clinical features and type of pain'.