[Opioid induction using rapid release drugs and the shift to fentanyl patches]

From April 2011 to March 2013, 20 patients with cancer pain that was not controlled by non-opioid analgesics were treated with a short-acting opioid for cancer pain management.The primary carcinoma sites were the stomach( n=5), colo-rectum(n=5), lungs(n=3), urinary bladder(n=2), breast(n=2), pancreas(n=2), and liver(n=1). The analgesic effects and adverse events were evaluated, and a shift to fentanyl patches was made for patients whose cancer pain was relieved.After the shift, the efficiency and safety were validated.

All 6 patients with a numeric rating scale (NRS)less than 5 at the time of opioid induction had a good analgesic effect, and in only 1 patient, grade 2 constipation and grade 3 anorexia was observed.Of the 14 patients who had an NRS of 6 or greater, 11 had a good analgesic effect.However, 3 patients experienced no effect, and their survival periods after opioid induction were very short.In the 11 patients with good pain control, only 3 patients exhibited grade 2 adverse events.Nine patients out of 17 with a good analgesic effect caused by short-acting opioids were shifted to fentanyl patches, and 8 patients were under good analgesic control for 2 weeks or more.

Opioid induction using rapid release drugs was effective and safe.However, these drugs should be clinically considered at an early stage.Furthermore, in patients where a shift to a fentanyl patch was possible, good long-term pain control was achieved.