Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain

Objectives To compare patients' preference for transdermal fentanyl or sust ained release oral morphine, their level of pain control, and their quality of life after treatment. Design Randomised, multicentre, international, open label, crossover trial. Setting 35 centres in Belgium, Canada, Denmark, Finland, the United Kingdom , the Netherlands, and South Africa. Participants 256 patients (aged 26-82 years) with chronic non-cancer pain w ho had been treated with opioids. Main outcome measures Patients' preference for transdermal fentanyl or sust ained release oral morphine, pain control, quality of life, and safety asse ssments. Results Of 212 patients, 138 (65%) preferred transdermal fentanyl, whereas 59 (28%) preferred sustained release oral morphine and 15 (7%) expressed no preference. Better pain relief was the main reason for preference for fent anyl given by 35% of patients. More patients considered pain control as bei ng "good" or "very good'' with fentanyl than with morphine (35% v 23%, P = 0.002). These results were reflected in both patients' and investigators' o pinions on the global efficacy of transdermal fentanyl. Patients receiving fentanyl had on average higher quality of life scores than those receiving morphine. The incidence of adverse events was similar in both treatment gro ups; however, more patients experienced constipation with morphine than wit h fentanyl (48% v 29%, P< 0.001). Overall, 41% of patients experienced mild or moderate cutaneous problems associated with wearing the transdermal fen tanyl patch, and more patients withdrew because of adverse events during tr eatment with fentanyl than with morphine (10% v 5%). However, within the su bgroup of patients naive to both fentanyl and morphine, similar numbers of patients withdrew owing to adverse effects (11% v 10%. respectively). Conclusion Transdermal fentanyl was preferred to sustained release oral mor phine by patients with chronic non-cancer pain previously treated with opio ids. The main reason for preference was better pain relief, achieved with l ess constipation and an enhanced quality of life.