High-Dose Fentanyl Patch for Cancer Pain of a Patient with cholangiocarcinoma
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We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 μg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 μg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain. (Korean J Intern Med 2010;25:337-340)
Abstract
We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 μg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 μg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain. (Korean J Intern Med 2010;25:337-340)
참고문헌 (11)
- Muijsers RB, "Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control", Drugs, 61, pp.2289~2307 (2001)
- Donner B, "Long-term treatment of cancer pain with transdermal fentanyl", J Pain Symptom Manage, 15, pp.168~175 (1998)
- Grond S, "Transdermal fentanyl in the long-term treatment of cancer pain: a prospective study of 50 patients with advanced cancer of the gastrointestinal tract or the head and neck region", Pain, 69, pp.191~198 (1997)
- Allan L, "Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain", BMJ, 322, pp.1154~1158 (2001)
- Skaer TL, "Management of pain in the cancer patient", Clin Ther, 15, pp.638~649 (1993)
- Zenz M, "Opiophobia and cancer pain in Europe", Lancet, 341, pp.1075~1076 (1993)
- Ward SE, "Patient-related barriers to management of cancer pain", Pain, 52, pp.319~324 (1993)
- Bercovitch M, "High dose morphine use in the hospice setting: a database survey of patient characteristics and effect on life expectancy", Cancer, 86, pp.871~877 (1999)
- Bercovitch M, "Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it?", Cancer, 101, pp.1473~1477 (2004)
- Mercadante S, "Addition of a second opioid may improve opioid response in cancer pain: preliminary data", Support Care Cancer, 12, pp.762~766 (2004)
- Bleeker CP, "Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain: a case report", Eur J Pain, 5, pp.325~329 (2001)