WESTPORT, CT (Reuters Health) Aug 22 - In the first long-term prospective
trial of opioid analgesia for the management of chronic noncancer pain, most
patients preferred transdermal fentanyl over previously used opioid medications,
according to a multinational research team.
Dr. Keith Milligan, of South Cleveland Hospital in Middlesbrough, UK, and colleagues enrolled patients with chronic pain of 8.8 years' mean duration who had been using one of 40 different potent opioids. There were 530 patients included in the safety analysis and 524 in the efficacy analysis. The mean starting dose of the fentanyl was 48 µg/hour, which was increased to 90 µg/hour by month 12.
At baseline, 72% of subjects responded to treatment, with 67% remaining stable over the course of the 12-month study, the investigators report in the August issue of the Journal of Pain. Eighty-nine percent of patients preferred fentanyl to their previous treatment, primarily because of better pain relief and increased convenience of use.
Most adverse events were of mild to moderate intensity, with similar incidence in those older than 65 compared with younger individuals. The most common adverse events considered possibly or definitely related to the fentanyl were nausea, constipation, somnolence, increased sweating, and vomiting. The incidence of adverse events did not increase with prolonged treatment.
There were no reports of addictive behavior among patients in the transdermal fentanyl group. "Fear of addiction is one of the reasons for the underuse of opioids in chronic noncancer pain," they write. The researchers believe "this study provides further evidence that these fears are unfounded."
J Pain 2001;2:197-204.
Copyright © 2001 Reuters Ltd