High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma.
10.3904/kjim.2010.25.3.337
- Author:
Jung Han KIM
1
;
Mi KIM
;
Chong Won SUNG
;
Hyeoung Su KIM
;
Hyun Joo JANG
;
Young Chul SHIN
;
Joo Young JUNG
Author Information
1. Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea. harricil@hotmail.com
- Publication Type:Case Report
- Keywords:
Fentanyl;
Neoplasms;
Pain;
Cholangiocarcinoma
- MeSH:
Administration, Cutaneous;
Analgesics, Opioid/administration & dosage;
Bile Duct Neoplasms/*drug therapy;
*Bile Ducts, Intrahepatic;
Cholangiocarcinoma/*drug therapy;
Fentanyl/*administration & dosage;
Humans;
Male;
Middle Aged;
Pain/*drug therapy/physiopathology;
Pain Measurement
- From:The Korean Journal of Internal Medicine
2010;25(3):337-340
- CountryRepublic of Korea
- Language:English
-
Abstract:
We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 microg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 microg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain.
