Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy

Ripamonti, Carla; Fagnoni, Elena; Campa, Tiziana; Brunelli, Cinzia; Conno, F. De

doi:10.1007/s00520-005-0918-0

Cited by 60 publications

(32 citation statements)

References 23 publications

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“…3 As such, it has become a popular choice in the management of cancer-related and chronic non-cancer-related pain. 4,5 The replacement of OxyContin with the tamper-resistant OxyNeo and the accompanying regulatory changes concerning long-acting oxycodone products have been associated with an increase in the use of fentanyl in some jurisdictions. 6,7 Unfortunately, problematic fentanyl use is increasing.…”

mentioning

confidence: 99%

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Friesen

Woelk

Bugden

2016

CMAJ

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mentioning

confidence: 99%

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Friesen

Woelk

Bugden

2016

CMAJ

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“…This is a practice which is aimed at the protection of a patient against onerousness associated with slowly progressing through the subsequent stages of the WHO analgesic ladder. The experiences to date indicate that such a procedure may bring about the desired effects in a large number of patients, and is relatively frequently applied in clinical practice and guidelines [9][10][11][12][13][14]. Unfortunately, in the presented case, it did not bring about the desired effect.…”

Section: Discussionmentioning

confidence: 95%

Opioid combination.

Brzeziński¹

2011

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The combination of long-acting opioids has not been sufficiently documented in the literature. Patient J.L., aged 67, with disseminated malignant process. Complaints of pelvic and visceral pain. Treatment: sustained release morphine 60 mg/daily. There occurred a need to increase the dose of the drug up to 120 mg/daily; the patient was referred to the Pain Management Outpatient Department. Nociceptive pain was diagnosed at the intensity of 7.5 on the VAS scale. Ketoprofen was included in the treatment at a dose of 200 mg/daily. After three days the morphine dose was increased to 180 mg/daily. Due to the lack of adequate pain control sustained release oxycodone was started, initially at a dose of 20 mg/ daily, and after three days 40 mg/daily. After two weeks, the dose of morphine was decreased to 140 mg/daily. Adequate pain control was obtained.K Ke ey y w wo or rd ds s: : opioid, morphine, oxycodone, opioid combination, pain management. Efficient management of pain in the course of cancer diseases often encounters serious difficulties [1,2]. A very frequent problem is, e.g. concomitant occurrence of many types of pain in the same patient. The course of the disease is often complicated by persistent post-surgical pain, pain related to bone metastases, neurogenic pain, or various types of neuropathic pain due to the infiltration of nerves, post-herpetic neuralgia, or chemotherapy-induced peripheral neuropathy. Unfortunately, very frequently there also occurs a lack of effectiveness of opioids, or a rapid increase in tolerance to the therapy applied.The principles of pain management, coded in the form of the WHO analgesic ladder, on assumption, introduce the principle of combining various drugs in order to increase their effectiveness, due to the use of combining and synergistic mechanisms [3]. Multimodal therapy in the form of opioids, non-steroid antiinflammatory drugs (NSAIDs) and co-analgesics, in the majority of cases allows efficient analgesia to be achieved, without the necessity for increasing the dosage of drugs, and often allows reduction of the amount of drugs applied.Simultaneous application of NSAIDs, opioids and co-analgesics, therefore, is the rule [4]; however, the administration of several drugs of the opioids group still evokes controversy. To date, few reports are available concerning the implementation of such a method of treatment [5]; therefore, it cannot be considered that there is scientific evidence which would justify such models of therapy [6]. At present, one can only rely on the opinion of experts that considering the variation in opioid receptors and varied susceptibility to exogenous ligands used, it is permissible to combine opioid drugs [5,6]. Case reportPatient J.L., aged 67, with endometrial cancer detected at the terminal stage. The patient was in a relatively good condition, in full possession of her faculties, running a household together with her daughter, totally independent. The complaints had started three months earlier, with intensifying pain in the pelvic bone radiating ...

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“…However, due to the nature of its long half-life, encountering toxicity is more commonplace, and thus its use is frequently reserved to those with the expertise. Transdermal Fentanyl, a patch usually applied to the anterior chest wall, which provides a longer duration of action and possibly lower abuse potential, is becoming the first line of treatment among some practitioners [19]. Alternatively, oxycodone has been shown to produce as much efficacy as morphine with a faster onset, fewer side effects [20], and improved pain control when morphine has failed [21].…”

Section: Medical Managementmentioning

confidence: 98%

Pain Management for Hepatobiliary Cancer

Halpert

Erdek

2008

Curr. Treat. Options in Oncol.

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Although many options exist to address hepatobiliary cancer-induced pain, it remains undertreated and has an adverse impact on quality of life. Fortunately, if addressed appropriately, the majority of patients can be treated successfully. This pain may be nociceptive, neuropathic, or a combination of the two. A multimodality approach including oral and intravenous opioid and non-opioid medications, and interventional approaches including celiac plexus blocks and implantation of drug delivery systems for intrathecal delivery of opioids can be considered and utilized as appropriate. We review the pathophysiology of pain, the approach to correctly diagnosing the different types of pain, the appropriate treatment recommendations, and how to avoid and address the common side effects resulting from these treatments.

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Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy

Abstract: There is a trend to use fentanyl patch as first-choice strong opioid in cancer patients in situations such as titration phase, in the presence of instable pain, and in the absence of dysphagia or gastrointestinal symptoms where the use of oral morphine is, however, not contraindicated.

Cited by 60 publications

References 23 publications

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Opioid combination.

Pain Management for Hepatobiliary Cancer

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