Opioids Switching with Transdermal Systems in Chronic Cancer Pain

<p>Abstract</p> <p>Background</p> <p>Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy</p> <p>Objective</p> <p>To assess the efficacy and tolerability of an a...

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Main Authors: Barbarisi M, Sansone P, Pota V, Pace MC, Aurilio C, Grella E, Passavanti MB
Format: Article
Language:English
Published: BMC 2009-05-01
Series:Journal of Experimental & Clinical Cancer Research
Online Access:http://www.jeccr.com/content/28/1/61
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spelling doaj-0c824b483e544b149aa2705f5a5ed2ec2020-11-24T22:08:47ZengBMCJournal of Experimental & Clinical Cancer Research1756-99662009-05-012816110.1186/1756-9966-28-61Opioids Switching with Transdermal Systems in Chronic Cancer PainBarbarisi MSansone PPota VPace MCAurilio CGrella EPassavanti MB<p>Abstract</p> <p>Background</p> <p>Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy</p> <p>Objective</p> <p>To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment.</p> <p>Methods</p> <p>A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks</p> <p>Results</p> <p>Pain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment.</p> <p>Conclusion</p> <p>Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.</p> http://www.jeccr.com/content/28/1/61
collection DOAJ
language English
format Article
sources DOAJ
author Barbarisi M
Sansone P
Pota V
Pace MC
Aurilio C
Grella E
Passavanti MB
spellingShingle Barbarisi M
Sansone P
Pota V
Pace MC
Aurilio C
Grella E
Passavanti MB
Opioids Switching with Transdermal Systems in Chronic Cancer Pain
Journal of Experimental & Clinical Cancer Research
author_facet Barbarisi M
Sansone P
Pota V
Pace MC
Aurilio C
Grella E
Passavanti MB
author_sort Barbarisi M
title Opioids Switching with Transdermal Systems in Chronic Cancer Pain
title_short Opioids Switching with Transdermal Systems in Chronic Cancer Pain
title_full Opioids Switching with Transdermal Systems in Chronic Cancer Pain
title_fullStr Opioids Switching with Transdermal Systems in Chronic Cancer Pain
title_full_unstemmed Opioids Switching with Transdermal Systems in Chronic Cancer Pain
title_sort opioids switching with transdermal systems in chronic cancer pain
publisher BMC
series Journal of Experimental & Clinical Cancer Research
issn 1756-9966
publishDate 2009-05-01
description <p>Abstract</p> <p>Background</p> <p>Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy</p> <p>Objective</p> <p>To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment.</p> <p>Methods</p> <p>A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks</p> <p>Results</p> <p>Pain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment.</p> <p>Conclusion</p> <p>Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.</p>
url http://www.jeccr.com/content/28/1/61
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