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Administering Pain Reliever by Nasal Spray Is Fast, Flexible

WebMD Health News

June 22, 2000 -- A new method of fast-acting pain control, in which patients give themselves doses of a powerful pain reliever with a nasal spray bottle, shows promise for people with chronic pain as well as those having surgery, a group of German researchers has found.

The researchers are testing this method for delivery of a short-acting but strong pain reliever called fentanyl. Researcher Hans Walter Striebel, MD, PhD, DEAA, tells WebMD that pain relievers like fentanyl are rapidly absorbed through the nose.

"We found our patients experienced as much pain relief as if they were taking intravenous medications," says Striebel, a professor of anesthesiology at the Municipal Hospital Frankfurt-Hochst, the teaching hospital of the J.W. Goethe University in Frankfurt.

Intravenous (IV) forms of patient-controlled pain medications are already available. Known as PCA pumps, these devices allow patients to give themselves another dose of pain medicine whenever they feel like it, rather than waiting for a nurse to do it. Both the nasal spray device and PCAs have limits, so patients can never give themselves too much medicine, or too much at one time.

But PCAs are not always convenient, since the patient must be hooked up to an IV machine delivering the medication. If the patient is at home, a nurse has to visit to make sure the PCA stays connected properly. Getting the same kind of pain relief from a small nasal spray bottle would be much easier.

The German research team tested their new method of pain relief on 48 patients who had just had surgery. Each could use both the nasal spray bottle and the PCA, so they didn't know which device was administering the actual medicine. Every few minutes, someone asked them how much pain they were feeling, and the researchers found that the nasal spray bottle and the PCA relieved pain equally well. Their study was published in the Canadian Journal of Anesthesia.

"This new method of pain relief could be used for any chronic pain patient with sudden flare-ups of severe pain, such as sickle cell and chronic pancreatitis patients," Jeffrey Wassermann, MD, director of the pain management clinic at Methodist Medical Center in Dallas, tells WebMD. Wasserman was not involved in the research.

James Crews, MD, an associate professor of anesthesiology at Wake Forest University School of Medicine in Winston-Salem, N.C., agrees. He adds that the nasal spray devices could be used to give extra relief to cancer patients who are already using slow-acting pain relievers such as morphine. "They could also be useful for AIDS-related pain," Crews says. "They could help patients doing physical therapy or respiratory therapy who have movement-associated pain and need a little boost."

In fact, the Frankfurt research team has already done studies using these methods to control this so-called breakthrough pain in home-based cancer patients, for weeks and months, with very good results, Striebel says. Soon, they'll begin testing the method in children, who are often afraid of shots.

Striebel says the results from the current research are very promising. Right now, the nasal spray device is only available in clinical studies, but he hopes that within two to three years they will be available to all pain patients.

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