Opioids Switching with Transdermal Systems in Chronic Cancer Pain

Abstract

BackgroundDue to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapyObjectiveTo assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment.MethodsA total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeksResultsPain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment.ConclusionOpioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.

Persistence with opioid treatment in Germany in patients suffering from chronic non-malignant or cancer pain

“…While the study population was small and follow-up periods were short (usually up to 6 weeks) in most studies conducted previously 7,12,[29][30][31][32][33][34][35][36][37] , our data provides follow-up information recorded up to 1 year after index date.…”

Effect of transdermal opioids in experimentally induced superficial, deep and hyperalgesic pain

“…On the other hand, transdermal fentanyl has been used widely in the treatment of pain associated with cancer (Jeal and Benfield, 1997). A clinical study showed that there were no differences in analgesia between buprenorphine and fentanyl when patients were switched between opioids (Aurilio et al ., 2009). However, to our knowledge there are no clinical studies showing analgesic differences between buprenorphine and fentanyl against bone‐associated pain.…”

End‐of‐Dose Pain in Chronic Pain: Does it Vary with the Use of Different Long‐Acting Opioids?

“…In 2 of 3 transdermal fentanyl studies, there was a decrease in the target outcomes. One study reported no change in BTP medication frequency or frequency of BTP from baseline …”