Actiq for breakthrough pain only?

Maybe: Actiq is not the best breakthrough pain medication in my opinion. It is expensive and from my experience doesn't work better than less expensive oral options. Also, fentanyl has a relatively short half life and i find that most of my patients who are prescribed breakthrough pain medication almost never have any left at the end of the month, so they are really using it as maintenence medication.

Actiq for BTP: It is a very good medication for btp - it has a short time to onset and an average duration of about 40-60min - resembles the btp identified in several studies. Because it is so effective one has to be careful not to rely on this for baseline pain. Regular oral meds are not good - they take too long to work (up to 45min) and the active metabolites last for 4-6 hours which is not good.

I believe: As far as i know, the only indication for Actiq is breakthrough pain in cancer patients with chronic pain. It is also used for non cancer breakthrough pain as an off label indication. I am not aware of any other uses for actiq. I would not use it as the basis for around the clock management of chronic pain. There are better, more effective and safer treatments.