Episodic pain is regarded as an everyday problem in palliative care patients that significantly interferes successful pain control and decreases health related quality of life. Usually this is a short lasting phenomenon, declining after half an hour. Traditionally applied morphine starts its effect too late, so does not meets expectations towards effective breakthrough pain relief. It remains good solution in prophylaxis of incidental pain though. Newly launched fentanyl formulations: buccal tablets and intranasal spray, act quicker and shorter, are well tolerated and meaningfully improve quality of pain control in terminally ill patients.