Transdermal fentanyl in opioid-naive cancer pain patients: An open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naive patients and a group using codeine

To treat cancer pain, physicans ofter decide to jump directly from step 1 o f the World Health Organizations (WHO) analgesic ladder to step 3. The use of transdermal fentanyl in patients with cancer pain who had either used no opioid before, or only codeine, is evaluated in the present trial. Both op ioid-naive (N = 14) and codeine-using (N = 14) patients started with transd ermal fentanyl in the lowest available delivery rate (25 mu g/hr). Immediat e-release oral morphine was present as "rescue" medication. Transdermal fen tanyl provided good to excellent pain relief in the majority (68%) of these patients. During the study, 5 patients continued with 25 mu g/hr, and the others used a higher dose. Clinically relevant respiratory depression was n ot observed. The common side effects of obioids were found; constipation wa s mentioned by 3 patients (11%). Transdermal fentanyl appeared a safe analg esic in these opioid-naive cancer pain patients. In this study, WHO step 2 could be skipped without untoward complications. (C) U.S. Cancer Pain Relie f Committee, 2000.