Transdermal fentanyl for cancer pain

Transdermal fentanyl might possibly be equally effective in reducing cancer pain in comparison to morphine or methadone, with lower rates of constipation.

The quality of evidence is downgraded by study limitations (incomplete outcome data) and by imprecise results (only small trials).

Summary

A Cochrane review included 9 studies with a total of 1382 patients to determine the analgesic efficacy of transdermal fentanyl for relief of cancer pain, and to assess the adverse events associated with the use. Treatment with transdermal fentanyl patches was compared to use of various formulations of morphine, methadone, and with paracetamol and codeine combination therapy. Patients with chronic pain of moderate to severe intensity, due to malignant disease were included.

There were insufficient comparable data for meta-analysis or for NNT (number needed to treat) analysis for the analgesic effect. In seven studies with 461 participants reporting pain intensity results after about two weeks, the mean or median pain intensity was decreased with pain scores on the borderline of mild and moderate pain. Most participants would have had no worse than mild pain on treatment. Another trial reported that 77% of participants using transdermal fentanyl had an undefined successful outcome. Fewer participants experienced constipation with transdermal fentanyl (28%) than with oral morphine (46%), giving a risk ratio (RR) of 0.61 (95% CI 0.47 to 0.78); the NNT to prevent constipation was 5.5 (95% CI 3.8 to 10).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Hadley G, Derry S, Moore RA et al. Transdermal fentanyl for cancer pain. Cochrane Database Syst Rev 2013;10():CD010270.