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[The opioid combination of transdermal fentanyl and sustained release morphine for refractory cancer pain--a case report].
Gan To Kagaku Ryoho. 2005 Nov; 32(12):1997-2000.GT

Abstract

Transdermal fentanyl (TDF) has been increasingly administered for the management of cancer pain. Occasionally, some patients fail to obtain poor analgesic effects with its dose escalation. We discuss a case of a 44-year-old male diagnosed with lung cancer with back pain caused by bone metastasis. He was administered a TDF of 75 microg/hr with good pain relief on admission. With time, the dose escalation to 300 microg/hr induced neuroexcitatory adverse effects without pain improvement. The conversion to 150 microg/hr TDF and sustained-release oral morphine 360 mg/day provided effective pain control. This clinical phenomenon demonstrated a possible association with the development of opioid tolerance. Although several experimental approaches regarding partial opioid substitution or combining different opioids for better pain control were suggested, the basic studies of opioid tolerance do not justify conclusions. In this case, partial opioid rotation and opioid combination were beneficial approaches to pain management.

Authors+Show Affiliations

Shakaihoken Kobe Central Hospital Palliative Care Unit.No affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

jpn

PubMed ID

16282744

Citation

Shinjo, Takuya, and Masakuni Okada. "[The Opioid Combination of Transdermal Fentanyl and Sustained Release Morphine for Refractory Cancer Pain--a Case Report]." Gan to Kagaku Ryoho. Cancer & Chemotherapy, vol. 32, no. 12, 2005, pp. 1997-2000.
Shinjo T, Okada M. [The opioid combination of transdermal fentanyl and sustained release morphine for refractory cancer pain--a case report]. Gan To Kagaku Ryoho. 2005;32(12):1997-2000.
Shinjo, T., & Okada, M. (2005). [The opioid combination of transdermal fentanyl and sustained release morphine for refractory cancer pain--a case report]. Gan to Kagaku Ryoho. Cancer & Chemotherapy, 32(12), 1997-2000.
Shinjo T, Okada M. [The Opioid Combination of Transdermal Fentanyl and Sustained Release Morphine for Refractory Cancer Pain--a Case Report]. Gan To Kagaku Ryoho. 2005;32(12):1997-2000. PubMed PMID: 16282744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The opioid combination of transdermal fentanyl and sustained release morphine for refractory cancer pain--a case report]. AU - Shinjo,Takuya, AU - Okada,Masakuni, PY - 2005/11/12/pubmed PY - 2005/12/13/medline PY - 2005/11/12/entrez SP - 1997 EP - 2000 JF - Gan to kagaku ryoho. Cancer & chemotherapy JO - Gan To Kagaku Ryoho VL - 32 IS - 12 N2 - Transdermal fentanyl (TDF) has been increasingly administered for the management of cancer pain. Occasionally, some patients fail to obtain poor analgesic effects with its dose escalation. We discuss a case of a 44-year-old male diagnosed with lung cancer with back pain caused by bone metastasis. He was administered a TDF of 75 microg/hr with good pain relief on admission. With time, the dose escalation to 300 microg/hr induced neuroexcitatory adverse effects without pain improvement. The conversion to 150 microg/hr TDF and sustained-release oral morphine 360 mg/day provided effective pain control. This clinical phenomenon demonstrated a possible association with the development of opioid tolerance. Although several experimental approaches regarding partial opioid substitution or combining different opioids for better pain control were suggested, the basic studies of opioid tolerance do not justify conclusions. In this case, partial opioid rotation and opioid combination were beneficial approaches to pain management. SN - 0385-0684 UR - https://www.unboundmedicine.com/medline/citation/16282744/[The_opioid_combination_of_transdermal_fentanyl_and_sustained_release_morphine_for_refractory_cancer_pain__a_case_report]_ L2 - http://www.pieronline.jp/openurl?issn=0385-0684&volume=32&issue=12&spage=1997 DB - PRIME DP - Unbound Medicine ER -