Wirz, S., Wittmann, M., Schenk, M., Schroeck, A., Schaefer, N., Mueller, M., . . . Nadstawek, J. (2009). Gastrointestinal symptoms under opioid therapy: A prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine. European Journal of Pain, 13, 737-743.

DOI Link

Study Purpose

To determine whether the transdermal opioids transdermal fentanyl (TDF) or transdermal buprenorphine (TDB) or oral sustained-release hydromorphone (OSRH) produced different gastrointestinal side effects.

Intervention Characteristics/Basic Study Process

Patients with nociceptive pain receiving one of the study drugs (TDF, TDB, or OSRH) over four weeks at a stable dose were identified. Medication adherence was checked daily.

Sample Characteristics

  • The study reported on a sample of 174 patients.
  • Mean patient age was 64.1 years (SD =11.6) in the TDF group, 65.3 years (SD = 10.7) in the TDB group, and 67.8 years (SD = 11.2) in the OSRH group.
  • The sample comprised 27 women and 28 men in the TDF group, 25 women and 36 men in the TDB group, and 24 women and 34 men in the OSRH group.
  • Patients were experiencing cancer-related pain.

Setting

  • Single site
  • Outpatient
  • Germany

Phase of Care and Clinical Applications

Not applicable

Study Design

This was a prospective, open-label, controlled study.

Measurement Instruments/Methods

  • Eastern Cooperative Oncology Group (ECOG) performance status
  • Selected European Organization for Research and Treatment of Cancer (EORTC) questionnaire items to assess constipation
  • Numeric Rating Scale (NRS)
  • Medications
  • Physical assessments daily for five days

Results

  • No difference existed between the groups in mean intensity scores for constipation.
  • Patients in the TDF group experienced slightly more constipation.
  • No difference existed between groups in laxative use.
  • TD narcotics caused more constipation than oral medication in this study.

Conclusions

TD narcotics caused more constipation than oral hydromorphone.

Limitations

  • The study lacked an appropriate control group.
  • Although this study disclosed the types of laxatives used, it did not differentiate whether one substance could have been more beneficial than another.

Nursing Implications

In this study, TD narcotics caused more constipation than the oral narcotic.