RESEARCH - Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain

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Curr Med Res Opin. 2004 Mar;20(3):259-67.

Use of transdermal fentanyl without prior opioid stabilization in patients

with cancer pain.

Tawfik MO, Bryuzgin V, Kourteva G; FEN-INT-20 Study Group.

National Cancer Institute, Cairo University, Cairo, Egypt. tawfik@...

OBJECTIVE: To determine the safety and efficacy of transdermal fentanyl for

pain relief in cancer patients and to compare the effects on patients

according to whether they had previously received strong opioids, weak

opioids or non-opioid analgesia. METHODS: Cancer patients requiring strong

analgesia were recruited into an open-label, multicentre study, conducted in

eight countries. Patients received transdermal fentanyl treatment for 28

days. Pain severity, overall satisfaction with pain control, convenience of

use of patches and treatment preferences were recorded daily. RESULTS: Of

the 292 participants, 135 had previously received a strong opioid, 84 had

previously received a weak opioid and 73 had received no regular opioids.

Thirty-eight patients did not complete the study, mainly due to adverse

events. For all groups the proportion of patients with 'good to excellent'

pain control increased after transdermal fentanyl treatment. Transdermal

fentanyl was well tolerated, with the most common treatment-related adverse

events being nausea, vomiting and constipation. The percentage of

strong-opioid-tolerant patients with constipation decreased following

transdermal fentanyl treatment and increased slightly in the

strong-opioid-naive groups. Most patients rated the convenience of the

patches as 'good to excellent', and most preferred transdermal fentanyl to

their previous therapy.

CONCLUSIONS: Transdermal fentanyl is an effective

and well-tolerated treatment for cancer-related pain for patients regardless

of whether they have previously received opioids. Previous guidelines have

often advocated initial dose finding with short-acting opioids but this

study demonstrates that such a complex titration and conversion schedule may

not be necessary,and that treatment may be initiated directly with

long-acting formulations such as transdermal fentanyl when previous

analgesic therapy fails to provide adequate relief.

PMID: 15025835

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15025835 & itool=iconabstr

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