Gastrointestinal symptoms under opioid therapy: A prospective comparison of oral sustained‐release hydromorphone, transdermal fentanyl, and transdermal buprenorphine

Abstract

Gastrointestinal symptoms of cancer pain patients undergoing an opioid therapy are related to multifactorial causes. Transdermal opioids showed no benefit over oral controlled-release hydromorphone with regard to gastrointestinal symptoms. The conversion ratios for transdermal fentanyl, transdermal buprenorphine, and oral hydromorphone did not accord to the literature, because of differing occurrences of opioid tolerance after long-term therapy.

Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries

“…Due to slow release of drug and avoiding sudden peaks in plasma drug levels, TDS also decreases the incidence of adverse effects associated with drugs. However, not all side effects are decreased as shown in some studies that the gastrointestinal side effects associated with oral and transdermal opioids are comparable [2].…”

Managing severe cancer pain: the role of transdermal buprenorphine: a systematic review

“…The main characteristics of the remaining 19 papers [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] are reported in Table 1. The 19 published articles described 16 different studies: Radbruch 29 presented the aggregated data from Bohme, 28 Sittl, 31 and Sorge; 32 Evans reported efficacy and safety data by pooling the 3 placebo-controlled RCTs; 25 and Radbruch 30 and Apolone 35 reported the preliminary information later published by Griessinger 33 and Apolone, 46 respectively.…”

“…Nine were clinical trials 28,31,32,37,[39][40][41][42]44 and 7 were observational (non-intervention) studies. 33,34,36,38,43,45,46 Most of the papers reported data from a mixed population including both cancer and non-cancer patients (12/19).…”

“…Wirz 45 conducted a controlled trial with the oral sustainedrelease hydromorphone, transdermal fentanyl, and buprenorphine on randomly selected 174 cancer patients, to assess the difference in terms of gastrointestinal symptoms in long-term treatment (all patients were pretreated with their current opioid therapy for more than 28 days). Patients were selected for participation by random selection from a sample of outpatients undergoing pain therapy with one of the study medications.…”

“…45 As 8 studies, 6 clinical trials 28,31,32,40,42,44 and 2 observational studies, 38,46 have used patients' reported pain intensity, we focused on this subsample. Table 3 presents the details of the studies that were candidates for a pooling analysis.…”