Efficacy and adverse effects of transdermal fentanyl and sustained-release oral morphine in treating moderate-severe cancer pain in Chinese population: a systematic review and meta-analysis

Abstract

BackgroundPrevious meta-analysis suggested that transdermal fentanyl was not inferior to sustained-release oral morphine in treating moderate-severe cancer pain with less adverse effects. Now, we updated the data and performed a systematic review.MethodsUpdated cohort studies on transdermal fentanyl and oral morphine in the treatment of cancer pain were searched in electronic databases including CBMdisc, CNKI, VIP, Medline, EMBASE and Cochrane Library. Primary end points assessed by meta-analysis were remission rate of pain and incidence of adverse effects. Quality of life was assessed by systematic review, which was the second end point.Results32 cohort studies, which included 2651 patients, were included in present study. The remission rate in transdermal fentanyl group and sustained-release oral morphine group were 86.60% and 88.31% respectively, there was no significant difference [RR = 1.13, 95% CI (0.92, 1.38), P = 0.23]. Compared with oral morphine group, there were less adverse effects in terms of constipation [RR = 0.35, 95% CI (0.27, 0.45), P < 0.00001], nausea/vomiting [RR = 0.57, 95% CI (0.49, 0.67), P < 0.00001], and vertigo/somnolence [RR = 0.59, 95% CI (0.51, 0.68), P < 0.00001] in transdermal fentanyl group. Six of selected trials supported either transdermal fentanyl or sustained-release oral morphine improved QOL of cancer patients and one of them showed more patients got better QOL after sustained-release oral morphine transferred to transdermal fentanyl.ConclusionsOur study showed again that both transdermal fentanyl and oral morphine had the same efficacy in the treatment of moderate-severe cancer pain in Chinese population, but the former might have less adverse effects and better quality of life.

Prophylactic use of laxative for constipation in critically ill patients

“…[10] The doses of narcotic agents used in both control and intervention groups were also similar and not statistically significant, which may supports our finding that early bowel movement <72 h in the intervention group was probably due to the laxative effect of lactulose prophylaxis.…”

Direct effects of morphine but not of fentanyl‐type opioids on human 5‐HT3A receptors in outside‐out patch‐clamp studies

“…Clinical studies support the view of morphine acting as a restrainer of gastrointestinal motility, more so than transdermal opioids, mainly fentanyl (Tassinari et al., ; Yang et al., ). Johnston () collected data that morphine induced even more nausea and vomiting than fentanyl‐type opioids, and suggested that this effect may depend on lipid solubility and the time point of administration.…”

“…Instead, current pharmacological therapeutic strategies focus on 5-HT4 receptor agonists to modulate the serotonergic enteric nervous system (Walters and Montagnini, 2010;Tack, 2011). Clinical studies support the view of morphine acting as a restrainer of gastrointestinal motility, more so than transdermal opioids, mainly fentanyl (Tassinari et al, 2008;Yang et al, 2010). Johnston (2010) collected data that morphine induced even more nausea and vomiting than fentanyl-type opioids, and suggested that this effect may depend on lipid solubility and the time point of administration.…”

Subdural haemorrhage is associated with recent morphine treatment in patients with cancer: A retrospective population-based nested case-control study

“…All opioids are considered effective in cancer pain management, but no studies that specifically address elderly patients with cancer are available [19,20]. Orally administered morphine is generally used for administering therapy for moderate-to-severe cancer pain; however, it presents adverse effects including constipation, nausea and vomiting, vertigo and somnolence [21]. In this study, the observed increased risk of SDH in morphine users may result from the increased risk of falling, head injury and subsequent SDH because of central nervous system effects such as vertigo.…”