Abstract ID: A33
Abstract Title: Transmucosal Fentanyl for Treatment of Non-malignant Pain: An Observational Study
Poster Type: Either
ABSTRACT BODY
Introduction: Pain is currently treated with a number of oral opioid medications. Transmucosal fentanyl (TMF) is an opioid indicated for opioid tolerant cancer patients but its prominent use is in nonmalignant pain. The following is an observational study of the use of TMF compared to other opioid medications in 34 patients with nonmalignant pain.
Method: A self-administered questionnaire was designed that captured the patient’s perception of pain reduction and the length of pain reduction in response to TMF. Additionally, the patients were asked to rate TMF in comparison to eleven commonly prescribed opioid medications they may have previously used. Thirty-four patients with nonmalignant pain who had used TMF for breakthrough pain for a minimum of one month, completed the questionnaire.
Results: The average length of pain relief reported was 3.3 hours (SD=1.5). The average number of breakthrough pain episodes was 3.8 (SD=1.6). Of the 34 subjects 13(38%) rated their pain reduction as very good, 12 (35%) as good, 8 (24%) as excellent and 1(3%) as slight. Of the eleven opioids used for comparison, five had been used by 50% or more of the subjects (propoxyphene with acetaminophen - 77%; acetaminophen with hydrocodone - 85%, acetaminophen with codeine - 767%; acetaminophen with oxycodone - 79%; and morphine – 59%). In a comparison of those five drugs to TMF, patients described the TMF as better 100% (propoxyphene with acetaminophen), 83% (acetaminophen with hydrocodone), 92% (acetaminophen with codeine), 83% (acetaminophen with oxycodone) and 40% (morphine) of the time. Thirty percent of the subjects described morphine as better while 30% indicated no difference between the morphine and the TMF. For each of the remaining six drugs used for comparison, greater than 86% of the subjects reported TMF as providing better pain relief.
Discussion: Currently the only approved use of transmucosal fentanyl is for malignant pain. However, it is frequently used in patients with non-malignant pain. Current literature focuses only on the use of TMF for malignant pain. This study examines the use of TMF in patients with non-malignant pain. The safety of TMF in normal subjects has previously been described. No subjects reported any serious side effects from the medication. Ninety-seven percent of the subjects indicated that TMF was good to excellent in reducing their pain. TMF was rated as providing relief equivalent or better than for nine out of the eleven other short-acting opioids. Hydrocodone and morphine analgesia was rated better than TMF by only 7% and 39% of subjects respectively. This study supports the safety and efficacy of TMF for management of non-malignant pain.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A33