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an to, MD l de C rgenc y its mmo ioid, tion in 5 minutes. According to our /$–see front matter may be due to thic syndromes, n, hemorrhage, ce, and the accu-ites, can shift the esia4 and poten-ugh to warrant ous fentanyl has for fast titration ies. The aim of e of intravenous orphine for fast ere admitted to mergency roomobservations, intravenous fentanyl could be safely used in the emergency room to treat patients who need fast titration of an opioid to control their pain. In our study, fentanyl was employed in a four-step protocol to treat patients admitted to our palliative care emergency room due to severe pain, regardless of the previous use of morphine at home. Titration with intravenous fentanyl was successfully employed in 18/18 (100%) patients, with an average time for pain control at about 11 minutes, and without relevant adverse effects. We conclude that intravenous fentanyl could be safely used for severe cancer pain when rapid titration is being considered. J Pain Symptom Manage 2003;26:876–881