According to the three step-ladder
analgesics in patients with
cancer pain, adjuvant drugs are required for
pain relief according to the
pain character and also to reduce side effects of
opioids.
Pain clinicians sometimes want to decide to jump directly from naive and mild
opioid to transdermal therapeutic system (TTS)
fentanyl with less side effects. We investigated the safety, efficacy, and satisfaction of the patients of TTS
fentanyl converting from
opioid-naive and mild-
opioid with adjuvant
drug medications in related to dose cascade of TTS
fentanyl. Both
opioid-naive (n=3) and
opioid-using (n=34) patients started with TTS
fentanyl in the lowest available delivery rate (25 microg/hr) with rescue medication. A numeric rating scale (NRS, from 0=no
pain to 10=worst
pain imaginable), satisfaction of the patients with the transdermal
therapy and side effects were recorded everyday during 29 days. Average reductions of NRS scores were 1.79 and 2.77, and the mean doses were 35.14 and 44.12 microg/hr on the 15th and 29th day, respectively. Reported level of satisfaction with the
transdermal patch and generalized
pain management were 'completely satisfied' and 'satisfied'. Frequent side effects were
nausea,
vomiting, and
constipation. In conclusion, initial application of TTS
fentanyl with proper adjuvant medications is effective, safe, and well tolerated.