DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20220515
Published: 2022-02-25

Compliance, efficacy and quality of life for oral morphine versus transdermal fentanyl patch in management of cancer pain

Gauridas Singha N., Arun Deka, Dipankar Dakua

Abstract


Background: A randomized, open, two-period, crossover study was done on cancer patients requiring strong opioid analgesia (n=104, mean age 63.5, range18-83 years) recruited from State Cancer Institute, Gauhati Medical College and Hospital, comparing transdermal fentanyl with oral morphine.

Methods: Patients received one treatment for 15 days followed immediately by the other for 15 days.

Results: Transdermal fentanyl provided good pain relief and it was also was associated with less constipation when compared to oral morphine(p<0.05). Of those who were able to express a preference, significantly more preferred fentanyl patches.

Conclusions: Transdermal fentanyl patch provided good pain relief, equivalent to that provided by oral morphine, required lesser rescue doses, improved quality of life and is associated with less constipation when compared to morphine, and was preferred more by patients.  


Keywords


Transdermal fentanyl, Morphine, Chronic pain, Cancer, Opioid analgesics

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References


Doyle KE, Elnakib S, Rajagopal MR, Babu S. Predictors and prevalence of pain and its management in four regional cancer hospitals in India. Journal of Global Oncology. 2018;4(4):1-9.

Textbook for Certificate Course in essentials of palliative care, Indian Association of Palliative Care. Fifth Edition(Reprint). 2018.

Wittwer E, Kern SE. Role of morphine’s metabolites in analgesia: concepts and controversies. AAPS J. 2006;8: E348-52.

Hasselstro¨m J, Sa¨we J. Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations. Clin Pharmacokinet. 1993;24:344-54.

Romberg R, Olofsen E, Sarton E. Pharmacokineticpharmacodynamic modeling of morphine-6-glucuronide-induced analgesia in healthy volunteers: absence of sex differences. Anesthesiology. 2004;100:120-33.

Davis MP. Fentanyl for breakthrough pain: a systematic review. Expert Rev Neurother. 2011;11:1197-216.

Peng PW, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults. Anesthesiology. 1999;90:576-99.

Feierman DE, Lasker JM. Metabolism of fentanyl, a synthetic opioid analgesic, by human liver microsomes. Role of CYP3A4. Drug Metabol Dispos. 1996;24:932-9.

Grond S, Radbruch L, Lehmann KA. Clinical pharmacokinetics of transdermal opioids: focus on transdermal fentanyl. Clin Pharmacokinet. 2000;38:59-89.

Ziesenitz VC, Konig SK, Mahlke NS, Skopp G, Haefeli WE, Mikus G. Pharmacokinetic interaction of intravenous fentanyl with ketoconazole. J Clin Pharmacol. 2015;55:708-17.

Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained release oral morphine in cancer pain: Preference, Efficacy and Quality of Life. Journal of Pain and Symptom Management. 1997;13(5).

Donner B. direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain. Pain. 1996.

Derby S, Chin J, Portenoy RK. Systemic opioid therapy for cancer pain: Practical guidelines for converting drugs and route of administration. CNS drugs. 1998;9:99-109.

Hanks GW, Conno FD, Cherry N. Morphine and alternative opioids in cancer pain: the EPAC recommendations. British Journal of Cancer. 2001:84(5):587-93.

Kim HJ, Kim YS, Park SH. Opioid rotation versus combination for cancer patients with chronic uncontrolled pain: a randomized study. BMC Palliative Care. 2015.

Benyamin R. Opioid complications and side effects. Pain Physician. 2008

Skyes NP. The relationship between opioid use and laxative use in terminally ill cancer patients. Palliative medicine. 1998;12:375-82.

Payne R. Chronic Pain. Challenges in the assessment and management of Cancer pain. J Pain Symptom Management. 2000;19:S12-5.