Transdermal fentanyl in the hospice: a survey of rescue dosing and pain control

The case records of 25 patients who received transdermal fentanyl as a primary analgesic during routine hospice care were surveyed for pain control and rescue medication use. The majority of patients (76 percent) had cancer-related pain and were treated in hospice for an average of approximately 30 days. Most received oral medications for supplemental rescue analgesia. During the sampling periods, on average, pain intensity was reported as mild. Over the same periods, patients required a mean of 6.1 (+/- 0.7) doses of rescue medication per day, with a range of zero to 12 doses per day. Five patients required rescue dosing every two hours on some treatment days. Although adequate pain control was generally accomplished with transdermal fentanyl in the group as a whole, the frequency of rescue dosing outside of the initial titration period appears unacceptably high.