Woodroffe M A, Hays H
Department of Family Medicine, University of Alberta, Edmonton.
Can Fam Physician. 1997 Feb;43:268-72.
About 65% of patients with advanced malignancies experience cancer pain. Although oral opioids provide effective analgesia for most of these patients, alternate routes of drug delivery are often necessary as the disease progresses.
To study use of Duragesic (fentanyl transdermal system), the only transdermal opioid approved in Canada for treating chronic cancer pain in adults.
Transdermal fentanyl was prescribed for a heterogeneous group of 44 patients (aged 29 to 82 years) to treat cancer pain (37 patients), chronic non-malignant pain (six patients), and pain associated with terminal AIDS (one patient), for periods of 2 to 384 days. Patients were treated individually and switched to transdermal fentanyl from other opioids when oral delivery was no longer possible. Doses were titrated as necessary and ranged from 25 micrograms/h to 300 micrograms/h. Incidental pain was treated effectively with short-acting opioids.
Eighty percent of patients experienced good analgesia, which led to an overall improvement in their quality of life. Transdermal fentanyl was discontinued for 17% of patients due to intractable nausea, diarrhea, adherence problems, or poor analgesia. Many patients wore the system until they died or until a few days before death when severe increasing pain necessitated parenteral opioids. The side effects of transdermal fentanyl were similar to those of conventional opioids. Patient compliance and acceptance of this noninvasive, continuous system of drug delivery has been excellent; its simplicity of administration allows patients to be cared for at home.
约65%的晚期恶性肿瘤患者会经历癌痛。尽管口服阿片类药物对大多数此类患者能提供有效的镇痛效果，但随着疾病进展，通常需要其他给药途径。
研究多瑞吉（芬太尼透皮贴剂系统）的使用，它是加拿大唯一获批用于治疗成人慢性癌痛的透皮阿片类药物。
为44名年龄在29至82岁的异质性患者群体开具了透皮芬太尼，用于治疗癌痛（37名患者）、慢性非恶性疼痛（6名患者）以及与晚期艾滋病相关的疼痛（1名患者），治疗时间为2至384天。患者接受个体化治疗，当无法进行口服给药时，从其他阿片类药物转换为透皮芬太尼。必要时调整剂量，范围为25微克/小时至300微克/小时。偶发性疼痛用短效阿片类药物有效治疗。
80%的患者获得了良好的镇痛效果，从而使其生活质量总体得到改善。17%的患者因难以忍受的恶心、腹泻、依从性问题或镇痛效果不佳而停用透皮芬太尼。许多患者一直使用该系统直至死亡，或在死亡前几天，当剧烈疼痛加剧需要胃肠外给予阿片类药物时停用。透皮芬太尼的副作用与传统阿片类药物相似。患者对这种无创、持续的给药系统的依从性和接受度极佳；其给药方式简单，使患者能够在家中接受护理。
