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Transdermal opioids for cancer pain
1College of Pharmacy, Washington State University, Wegner Hall Room 105, PO BOX 646510, Pullman, WA 99164-6510, USA. tskaer@wsu.edu
Health and Quality of Life Outcomes
|April 1, 2006
Summary
Optimizing opioid therapy for cancer pain is crucial. A more aggressive dosing strategy for transdermal fentanyl, using a 2:1 ratio, can improve pain management and quality of life for patients with malignancy-related pain.
Area of Science:
- Oncology
- Pain Management
- Pharmacology
Background:
- Moderate to severe malignancy-related pain often necessitates opioid pharmacotherapy.
- Subtherapeutic opioid dosing in cancer patients leads to suffering and reduced quality of life.
Purpose of the Study:
- To evaluate the efficacy of individualized opioid pharmacotherapy for cancer pain.
- To address the limitations of current equianalgesic dosing recommendations for transdermal fentanyl.
Main Methods:
- Review of literature and clinical experience to develop a more aggressive dosing algorithm for transdermal fentanyl.
- Comparison of transdermal fentanyl and transdermal buprenorphine for cancer pain management.
Main Results:
- Current manufacturer recommendations for transdermal fentanyl may result in subtherapeutic initial doses.
- An aggressive 2:1 (oral morphine: transdermal fentanyl) conversion ratio may optimize pain relief.
- Transdermal buprenorphine's properties may limit its use in advanced cancer pain patients requiring high opioid doses.
Conclusions:
- Individualized assessment of pain intensity and etiology is essential for selecting analgesic pharmacotherapy.
- A revised, more aggressive dosing algorithm for transdermal fentanyl can improve cancer pain management.
- Transdermal buprenorphine may not be suitable for all cancer pain patients, particularly those with advanced, unremitting pain requiring high opioid doses.
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