Transdermal Fentanyl in Opioid-Naive Cancer Pain Patients

Vielvoye-Kerkmeer, A. P. E.; Mattern, Carlien; Uitendaal, M.P.

doi:10.1016/s0885-3924(99)00152-9

Cited by 60 publications

(8 citation statements)

References 6 publications

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“…At the end of an unreported duration of treatment, 86% of respondents stated that they had at least a 75% pain reduction and 96% had at least a 50% pain reduction. Similarly, Vielvoye-Kerkmeer et al 49 had respondents rate the effectiveness of their treatment as “poor”, “moderate”, “good”, or “excellent”. In their study, 69%–71% of patients rated their pain relief as “good” or “excellent”.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Carlson

2016

JPR

134

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Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Carlson

2016

JPR

134

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“…A good analgesic effect was achieved in 11 patients, with a partial effect in an additional 2 patients. TF was effective and well tolerated in patients formerly treated with weak opioids that did not provide satisfactory analgesia [37]. The indications for TF include patients’ preferences, intense constipation during morphine treatment, morphine intolerance, nausea, and vomiting.…”

Section: Opioids For Moderate-to-severe Pain (Strong Opioids)mentioning

confidence: 99%

Pain Management in Patients with Cancer: Focus on Opioid Analgesics

Leppert

2011

Curr Pain Headache Rep

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Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant analgesics. Weak opioids are used for mild-to-moderate pain as monotherapy or in a combination with nonopioids. For patients with moderate-to-severe pain, strong opioids are recommended as initial therapy rather than beginning treatment with weak opioids. Adjunctive therapy plays an important role in the treatment of cancer pain not fully responsive to opioids administered alone (ie, neuropathic, bone, and visceral colicky pain). Supportive drugs should be used wisely to prevent and treat opioids’ adverse effects. Understanding the pharmacokinetics, pharmacodynamics, interactions, and cautions with commonly used opioids can help determine appropriate opioid selection for individual cancer patients.

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“…Although TDF demonstrated a similar effectiveness to oral strong opioids in cancer patients under various conditions [ 15 , 21 , 22 , 23 , 24 ], little data were available regarding treatment with low-dose TDF in cancer patients with moderate-to-severe pain intensity [ 16 ]. The current study demonstrates that a low-dose of starting TDF could be effective in the opioid-naïve patients suffering from significant cancer pain.…”

Section: Discussionmentioning

confidence: 99%

“…Of the previous studies of TDF for cancer pain [ 12 ], most used 25 µg/hr as starting dose, which is equiva lent to 60 mg MEDD. However, the abrupt introduction of this dose to opioid-naïve patients might expose the subjects to a high-risk of adverse effects and subsequently decreased compliance [ 13 , 15 , 28 ]. A cancer pain study in opioid-naïve patients who started strong opioids at the ranges of 50 to 60-mg MEDD reported that as many of 36% of patients prematurely discontinued the trial due to AE [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of TDF has been confirmed in varying intensities of cancer pain [ 11 , 12 , 13 , 14 ]. The commonly used formation of 25 µg/hr TDF is a relatively high dose (a morphine equivalent daily dose [MEDD] of ≥ 60 mg/day) in opioid-naïve patients; therefore, patients are likely to experience adverse events (AEs) [ 15 ]. Starting with low doses of TDF might be an alternative strategy to avoid this pitfall.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of low-dose transdermal fentanyl in opioid-naïve cancer patients with moderate-to-severe pain

Kang

Song

et al. 2015

Korean J Intern Med

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Background/AimsLittle is known about the efficacy of low-dose transdermal fentanyl (TDF) patches in opioid-naïve patients with moderate-to-severe cancer pain.MethodsThis study had an open-label, prospective design, and was conducted between April 2007 and February 2009 in seven tertiary cancer hospitals; 98 patients were enrolled. TDF was started using a low-dose formulation (12.5 µg/hr), and the dose was adjusted according to the clinical situation of individual patients. Pain intensity, the TDF doses used, and adverse events (AEs) were monitored over 4 weeks. Data were analyzed using the intent-to-treat and per-protocol principles.ResultsOf the 98 patients enrolled, 64 (65%) completed the study. The median pain intensity decreased from 6.0 to 3.0 (p < 0.001) at the follow-up visit. The efficacy of low-dose TDF on pain relief was consistent across groups separated according to gender (p < 0.001), age (p < 0.001), metastasis (p < 0.001), previous treatment (p < 0.001), and baseline pain intensity (p < 0.001). The decrease in pain intensity was significantly greater in the severe group compared with the moderate group (mean ± SD, 5.10 ± 2.48 vs. 2.48 ± 1.56; p < 0.001). TDF dose (27.8 µg/hr vs. 24.8 µg/hr, p = 0.423) and the mean treatment time (7.5 days vs. 7.9 days, p = 0.740) required for pain control were not different between the two pain-intensity groups. Patients had AEs of only mild or moderate intensity; among these, nausea (38%) was the most common, followed by vomiting (22%) and somnolence (22%).ConclusionsLow-dose TDF was an effective treatment for patients with cancer pain of moderate-to-severe intensity. Further randomized trials assessing the efficacy of TDF for severe pain and/or optimal starting doses are warranted.

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Transdermal Fentanyl in Opioid-Naive Cancer Pain Patients

Cited by 60 publications

References 6 publications

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

Pain Management in Patients with Cancer: Focus on Opioid Analgesics

The efficacy of low-dose transdermal fentanyl in opioid-naïve cancer patients with moderate-to-severe pain

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