Abstract
PROBLEM BEING ADDRESSED: About 65% of patients with advanced malignancies experience cancer pain. Although oral opioids provide effective analgesia for most of these patients, alternate routes of drug delivery are often necessary as the disease progresses. PURPOSE OF PROGRAM: To study use of Duragesic (fentanyl transdermal system), the only transdermal opioid approved in Canada for treating chronic cancer pain in adults. MAIN COMPONENTS: Transdermal fentanyl was prescribed for a heterogeneous group of 44 patients (aged 29 to 82 years) to treat cancer pain (37 patients), chronic non-malignant pain (six patients), and pain associated with terminal AIDS (one patient), for periods of 2 to 384 days. Patients were treated individually and switched to transdermal fentanyl from other opioids when oral delivery was no longer possible. Doses were titrated as necessary and ranged from 25 micrograms/h to 300 micrograms/h. Incidental pain was treated effectively with short-acting opioids. CONCLUSIONS: Eighty percent of patients experienced good analgesia, which led to an overall improvement in their quality of life. Transdermal fentanyl was discontinued for 17% of patients due to intractable nausea, diarrhea, adherence problems, or poor analgesia. Many patients wore the system until they died or until a few days before death when severe increasing pain necessitated parenteral opioids. The side effects of transdermal fentanyl were similar to those of conventional opioids. Patient compliance and acceptance of this noninvasive, continuous system of drug delivery has been excellent; its simplicity of administration allows patients to be cared for at home.
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Selected References
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- Arroyo J. F., Cohen M. L. Adverse effects of topical capsaicin in refractory cervicobrachial pain. J Pain Symptom Manage. 1992 Jan;7(1):1–2. doi: 10.1016/0885-3924(92)90099-4. [DOI] [PubMed] [Google Scholar]
- Ferrell B. R., Cohen M. Z., Rhiner M., Rozek A. Pain as a metaphor for illness. Part II: Family caregivers' management of pain. Oncol Nurs Forum. 1991 Nov-Dec;18(8):1315–1321. [PubMed] [Google Scholar]
- Ferrell B. R., Ferrell B. A., Ahn C., Tran K. Pain management for elderly patients with cancer at home. Cancer. 1994 Oct 1;74(7 Suppl):2139–2146. doi: 10.1002/1097-0142(19941001)74:7+<2139::aid-cncr2820741722>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
- Holley F. O., van Steennis C. Postoperative analgesia with fentanyl: pharmacokinetics and pharmacodynamics of constant-rate i.v. and transdermal delivery. Br J Anaesth. 1988 May;60(6):608–613. doi: 10.1093/bja/60.6.608. [DOI] [PubMed] [Google Scholar]
- Kunz K. M., Theisen J. A., Schroeder M. E. Severe episodic pain: management with sublingual sufentanil. J Pain Symptom Manage. 1993 May;8(4):189–190. doi: 10.1016/0885-3924(93)90125-f. [DOI] [PubMed] [Google Scholar]
- Lehmann K. A., Zech D. Transdermal fentanyl: clinical pharmacology. J Pain Symptom Manage. 1992 Apr;7(3 Suppl):S8–16. doi: 10.1016/0885-3924(92)90048-m. [DOI] [PubMed] [Google Scholar]
- Librach S. L. Special issues in pain control during terminal illness. Can Fam Physician. 1995 Mar;41:415–419. [PMC free article] [PubMed] [Google Scholar]
- Miser A. W., Narang P. K., Dothage J. A., Young R. C., Sindelar W., Miser J. S. Transdermal fentanyl for pain control in patients with cancer. Pain. 1989 Apr;37(1):15–21. doi: 10.1016/0304-3959(89)90148-6. [DOI] [PubMed] [Google Scholar]
- Stanley T. H. The history and development of the fentanyl series. J Pain Symptom Manage. 1992 Apr;7(3 Suppl):S3–S7. doi: 10.1016/0885-3924(92)90047-l. [DOI] [PubMed] [Google Scholar]
- Taylor E. J., Ferrell B. R., Grant M., Cheyney L. Managing cancer pain at home: the decisions and ethical conflicts of patients, family caregivers, and homecare nurses. Oncol Nurs Forum. 1993 Jul;20(6):919–927. [PubMed] [Google Scholar]
- Varvel J. R., Shafer S. L., Hwang S. S., Coen P. A., Stanski D. R. Absorption characteristics of transdermally administered fentanyl. Anesthesiology. 1989 Jun;70(6):928–934. doi: 10.1097/00000542-198906000-00008. [DOI] [PubMed] [Google Scholar]
- Ventafridda V. Considerations on cancer pain management. J Palliat Care. 1987 Dec;3(2):6–7. [PubMed] [Google Scholar]
- Walsh T. D., West T. S. Controlling symptoms in advanced cancer. Br Med J (Clin Res Ed) 1988 Feb 13;296(6620):477–481. doi: 10.1136/bmj.296.6620.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yee L. Y., Lopez J. R. Transdermal fentanyl. Ann Pharmacother. 1992 Nov;26(11):1393–1399. doi: 10.1177/106002809202601113. [DOI] [PubMed] [Google Scholar]
