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Dylan Nguyen
Dylan Nguyen

Pain Patch For Cancer Patients

Fentanyl patches can already be prescribed on the Pharmaceutical Benefits Scheme for chronic severe cancer pain. The listing has changed from August 2006 to include chronic non-cancer pain. Listing was approved on a cost-minimisation basis, that is, transdermal fentanyl was no less effective than oral sustained-release morphine, and for similar cost.

Pain Patch For Cancer Patients

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Reserve fentanyl patches for patients with chronic pain and established opioid needs who are unable to take oral morphine. Fentanyl patches can be useful when morphine cannot be used in severe renal impairment or when the oral route cannot be used because of vomiting or difficulty swallowing.6,7 Individual response to opioids varies and some patients might experience uncontrollable adverse effects or poor analgesic response to morphine; in such cases fentanyl is one of several alternative opioids that might be considered.6,7(See Evidence for fentanyl compared with other opioids and Adverse effects).

Discuss and agree on the specific goals of therapy with the patient and document these before embarking on opioid therapy; in non-cancer pain these would include pain relief, functional improvement and quality of life. If goals are not achieved after a reasonable trial, consider stopping the medication.10,11

There is little good-quality published trial evidence comparing fentanyl with other analgesics in chronic non-cancer pain, and no blinded trials. Most guidelines are based on clinical experience and consensus.7,11,12

The available evidence suggests no efficacy advantage over standard opioids. A large, randomised open-label trial (n = 680) in patients with chronic lower back pain found similar effects on pain measured with a visual analogue scale (VAS) when transdermal fentanyl was compared with oral sustained-release morphine.13 A smaller open-label trial in which patient preference was the primary outcome found small differences in mean VAS ratings, but these were unlikely to be of clinical significance.14 Some studies have shown that patients prefer fentanyl patches for pain relief over oral morphine, but the lack of blinding means factors other than efficacy cannot be ruled out (e.g. novelty of the delivery mechanism).14,15

Ideally all patients should have had recent strong-opioid exposure before starting fentanyl patches. Do not prescribe to opioid-naïve patients with non-cancer pain. If prescribing to opioid-naïve patients with cancer pain, always initiate therapy with the lowest strength patch (12 micrograms per hour). (See above Risks in opioid-naive patients).

When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single-dose studies, and there is substantial individual variation in response.2,7 The dose-conversion ranges provided by the manufacturer are only a guide (Tables 1 and 2).8 Consider using a lower-dose patch initially then titrating upwards.2

Ensure that patients know how to use and dispose of fentanyl patches. Patches should be folded with the sticky sides together, wrapped and disposed of either by returning to the pharmacist, or placing in the garbage well out of reach.

Suggest or provide the Durogesic consumer medicine information (CMI) leaflet. Illustrated leaflets explaining how to use the patches are available to doctors, pharmacists and patients from Janssen-Cilag.

Fentanyl patches may be habit forming, especially with prolonged use. Use the fentanyl patch exactly as directed. Do not apply more patches, apply the patches more often, or use the patches in a different way than prescribed by your doctor. While using fentanyl patches, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or has had an overdose, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse fentanyl patches if you have or have ever had any of these conditions. Talk to your health care provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Fentanyl patches may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Because of this serious risk, fentanyl patches should only be used to treat people who are tolerant (used to the effects of the medication) to opioid medications because they have taken this type of medication for at least one week and should not be used to treat mild or moderate pain, short-term pain, pain after an operation or medical or dental procedure, or pain that can be controlled by medication that is taken as needed. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to use fentanyl patches. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), a head injury, a brain tumor, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.

Fentanyl patches are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. Fentanyl is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Do not stop using fentanyl patches without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop using fentanyl patches you may have symptoms of withdrawal. Call your doctor if you experience any of these symptoms of withdrawal: restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, large pupils (black circles in the center of the eyes), irritability, anxiety, backache, pain in the joints, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast heartbeat, or rapid breathing.

Layout table for study information Study Type : Interventional (Clinical Trial) ActualEnrollment : 30 participants Allocation: Randomized Intervention Model: Crossover Assignment Masking: Triple (Participant, Care Provider, Investigator) Primary Purpose: Supportive Care Official Title: The Efficacy Of Lidocaine Patch In The Management Of Postsurgical Neuropathic Pain In Patients With Cancer: A Phase III Double-Blind, Crossover Study Study Start Date : May 2004 Actual Primary Completion Date : July 2006 Actual Study Completion Date : July 2007 Resource links provided by the National Library of Medicine Drug Information available for: Lidocaine hydrochloride Lidocaine U.S. FDA Resources Arms and Interventions Go to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Arm Intervention/treatment Active Comparator: Lidocaine patchParticipants will be instructed to apply a patch or patches (up to 3 maximum simultaneously) directly to the affected area. The patch(es) should be applied during awake hours and then left on continuously for approximately 18 hours or until usual bedtime sleep. Drug: lidocaine Placebo Comparator: Placebo patchParticipants will be instructed to apply a patch or patches (up to 3 maximum simultaneously) directly to the affected area. The patch(es) should be applied during awake hours and then left on continuously for approximately 18 hours or until usual bedtime sleep. Other: placebo Outcome Measures Go to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Primary Outcome Measures : Pain intensity rating (NRS) [ Time Frame: 4 and 8 weeks ] Secondary Outcome Measures : Pain as assessed by the Brief Pain Inventory-Short Form, Neuropathy Pain Scale, Subject Global Impression of Change, Pain Catastrophizing Scale, Profile of Mood States Short Form, and NCCTG Quality of Life [ Time Frame: 8 weeks ] Incidence of each toxicity reported in each treatment period [ Time Frame: 8 weeks ] Maximum severity reported of each toxicity [ Time Frame: 8 weeks ] Distribution of the overall toxicity score [ Time Frame: 8 weeks ] Proportion of patients who report a preference for lidocaine patch or placebo at study completion [ Time Frame: 8 weeks ] Proportion of patients who terminate treatment prematurely [ Time Frame: up to 8 weeks ] Eligibility CriteriaGo to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Layout table for eligibility information Ages Eligible for Study: 18 Years to 120 Years (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria DISEASE CHARACTERISTICS: 041b061a72


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