Korean J Intern Med.  2010 Sep;25(3):337-340. 10.3904/kjim.2010.25.3.337.

High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma

• Kim JH
• Kim M
• Sung CW
• Kim HS
• Jang HJ
• Shin YC
• Jung JY

• KMID: 1776617
• DOI: http://doi.org/10.3904/kjim.2010.25.3.337

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.

Keyword

Fentanyl; Neoplasms; Pain; Cholangiocarcinoma

MeSH Terms

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