An alternative algorithm for dosing transdermal fentanyl for cancer-related pain

Many cancer patients are undermedicated and inappropriately managed for pai n, leading to a diminished quality of life, Patients with moderate to sever e pain often require opioid analgesics, Recently published guidelines empha size individualization of opioid treatment to provide the drug and route of administration that meet the needs of the particular patient. Intolerable side effects, ineffective pain relief, or a change in the patient's clinica l status can dictate the need for a new pain management regimen. Physicians must be able to readily quantify relative analgesic potency when convertin g from one opioid to another or from one route of administration to another . Transdermal fentanyl (Duragesic) is an opioid agonist that has been shown to be safe and effective for the treatment of cancer pain. However, clinic ians should realize that the manufacturer's recommendations for equianalges ic dosing of transdermal fentanyl may result in initial doses that are too low in some patients, and in a titration period that is too long. Under the se circumstances, the patient is likely to experience unrelieved pain, An a lternative dosing algorithm that considers both a review of the literature and our combined clinical experience with transdermal fentanyl should help clinicians individualize the treatment of pain.