Aurilio, C., Pace, M.C., Pota, V., Sansone, P., Barbarisi, M., Grella, E., & Passavanti, M.B. (2009). Opioids switching with transdermal systems in chronic cancer pain. Journal of Experimental & Clinical Cancer Research, 28, 61.doi: 10.1186/1756-9966-28-61
To evaluate the analgesic and side effects that result from switching between transdermal buprenorphine and transdermal fentanyl
Patients had an initial screening visit so investigators could obtain historical data. Patients who met inclusion criteria returned one week later for recruitment. Each patient received a diary in which to rate pain each morning, on a visual analog scale (VAS), and in which to record use of rescue pain medication. Any patients who had taken buprenorphine 70 mcg/hour continuously during the prior week and who had suffered side effects and refractory pain had his or her patch replaced by a 25 mcg/hour transdermal fentanyl patch. The fentanyl patch was positioned at a site different from the site of the previous patch. Patients who had taken fentanyl 75 mcg/hour during the prior week and who had suffered similar side effects and pain were switched to a 52.5 mcg/hour transdermal buprenorphine patch positioned on a different skin site. Rescue medication, 20 mg immediate-release oral morphine up to three times daily, was prescribed to each patient. Patients were followed for four weeks and seen weekly in the clinic for study assessments.
This was a single-site, outpatient study conducted in Naples, Italy.
The was a prospective trial.
Findings indicate that, by replacing burprenorphine and fentanyl transdermal delivery with a 50% reduction in the new opioid dose, investigators achieved a significant reduction in pain and the need for short-term rescue medication.
This study did not use equianalgesic doses when opioids were switched. This suggests that, at least initially, lower doses of the new drug may have been effective and reduced side effects. Further studies are warranted to continue the development of safe and effective opioid-switching methods.