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High-dose fentanyl patch for cancer pain.
Sasson Menahem1, Pesach Shvartzman
1Pain and Palliative Unit, Department of Family Medicine, Sial Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, and Clalit Health Services-South District, Beer-Sheva, Israel. sassonm@bezeqint.net
The Journal of the American Board of Family Practice
|September 10, 2004
Summary
High-dose transdermal fentanyl (1000 microg/hr) effectively managed severe cancer pain in a hospice patient. This approach offers significant relief for advanced malignancy pain.
Area of Science:
- Oncology
- Palliative Care
- Pain Management
Background:
- Cancer pain management remains a significant challenge, particularly in advanced stages.
- Opioid therapy is a cornerstone of cancer pain control.
- Transdermal fentanyl offers a continuous delivery system for sustained pain relief.
Observation:
- A 62-year-old male with advanced rectal carcinoma experienced severe anal pain (10/10) despite receiving 150 microg/hr transdermal fentanyl.
- Adjuvant therapies including amitriptyline and dexamethasone did not provide adequate pain relief.
- Gradual dose escalation of transdermal fentanyl to 1000 microg/hr resulted in significant pain reduction (1-4/10).
Findings:
- High-dose transdermal fentanyl (1000 microg/hr) achieved substantial and sustained pain control in a patient with advanced cancer.
- The patient remained mentally alert with good pain management throughout the treatment period.
- Successful titration to high-dose transdermal fentanyl was achieved in a hospice setting.
Implications:
- High doses of transdermal fentanyl (up to 1000 microg/hr) should be considered as a viable option for managing severe cancer pain.
- This case highlights the potential efficacy of aggressive opioid titration in palliative care.
- Further research into the safety and efficacy of high-dose transdermal fentanyl in diverse cancer populations is warranted.