J Korean Soc Spine Surg.  2014 Dec;21(4):167-173. 10.4184/jkss.2014.21.4.167.

Clinical Usefulness of Fentanyl Matrix Patch for the Patients with Chronic Low Back Pain

• Chung GY
• Chung NS
• Seo HS
• Jeon CH

• KMID: 2097867
• DOI: http://doi.org/10.4184/jkss.2014.21.4.167

Abstract

STUDY DESIGN: Prospective observational study.
OBJECTIVES
The aim of this study was to examine the usefulness of a fentanyl matrix patch in the management of chronic low back pain. SUMMARY OF LITERATURE REVIEW: Chronic low back pain is a significant disabling disease with high medical costs and socioeconomical effects. Oral medication is a fundamental tool for conservative treatment. The fentanyl matrix patch is currently regarded as an alternative method for oral medication, however, the usefulness of the fentanyl matrix patch has not been fully evaluated.
MATERIALS AND METHODS
From September 2008 to May 2009, a multicenter, open, prospective observational study was conducted. The inclusion criteria included chronic pain patients that did not respond to conservative pain management. The clinical usefulness was evaluated with pain intensity, and the KEQ-5D (Korean version of Euro QoL-5 dimension).
RESULTS
Overall, 538 patients were included in this study. The pain intensity decreased about 1.84 +/- 1.91 at the second visit and further decreased by about 2.52 +/- 2.34 at the third visit (p<0.0001). The KEQ-5D score decreased about 0.12 +/- 0.18 at the second visit, and decreased further to 0.18 +/- 0.24 at the third visit (p<0.0001). The number of patients with adverse effects was 121 (22.49%).
CONCLUSIONS
The fentanyl matrix patch improves the pain and disability in patients with chronic low back pain. It is a useful alternative method for the management of chronic low back pain.

Keyword

Chronic low back pain; Fentanyl; Matrix patch; Safety; Effectiveness

MeSH Terms

Chronic Pain
Fentanyl*
Humans
Low Back Pain*
Observational Study
Pain Management
Prospective Studies
Fentanyl

Reference

1. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001; 344:363–70.

2. Patel AT, Ogle AA. Diagnosis and management of acute low back pain. American family physician. 2000; 61:1779–86.

3. Portenoy RK. Managing cancer pain poorly responsive to systemic opioid therapy. Oncology. 1999; 13:25–9.

4. World Health Organization. Cancerpainrelief,2nded. Geneva: WHO;1996.

5. McQuay H. Opioids in pain management. Lancet. 1999; 353:2229–32.

6. Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. Journal of pain and symptom management. 1996; 11:203–17.

7. Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology. 1991; 41:1024–8.

8. Dellemijn PL, Vanneste JA. Randomised double-blind active-placebo-controlled crossover trial of intravenous fentanyl in neuropathic pain. Lancet. 1997; 349:753–8.

9. van Tulder MW, Scholten RJ, Koes BW, et al. Nonsteroidal antiinflammatory drugs for low back pain: a systematic review within the framework of The Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2000; 25:2501–13.

10. Deyo RA. Drug therapy for back pain. Which drugs help which patients? Spine (Phila Pa 1976). 1996; 21:2840–9.

11. Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opioid analgesic. J Pharmacol Exp Ther. 1992; 260:275–85.

12. Peloso PM, Fortin L, Beaulieu A, et al. Analgesic efficacy and safety of tramadol/acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: a multicenter, outpatient, randomized, double blind, placebo controlled trial. J Rheumatol. 2004; 31:2454–63.

13. Ruoff GE, Rosenthal N, Jordan D, et al. Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Clin Ther. 2003; 25:1123–41.

14. Cox ER, Motheral B, Frisse M, Behm A, Mager D. Pre-scribing COX-2s for patients new to cyclo-oxygenase in-hibition therapy. Am J Manag Care. 2003; 9:735–42.

15. New fentanyl warning: more needed to protect patients. ISMP Medication Safety Alert! August 11, 2005. Avail-able at. http://www.ismp.org/newsletters/acutecare/ar-ticles/20050811.asp.

16. Mather LE. Clinical pharmacokinetics of fentanyl and its newer derivatives. Clin Pharmacokinet. 1983; 8:422–46.

17. Anderson DT, Muto JJ. Duragesic transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. J Anal Toxicol. 2000; 24:627–34.

18. Physicians Desk Reference. 2008. ) (. 62nd edition. Thompson Healthcare Inc;.,. Montvale, New Jersey:

19. Park JM. Cancer pain. Korean Society of Anesthesiolo-gists Anesthesiology & pain medicine. 2nd ed.Seoul: Ryo Moon Gak;2010. p. 379–98.

20. Kornick CA, Santiago-Palma J, Khojainova N, et al. A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl. Cancer. 2001; 92:3056–61.

21. Rose PG, Macfee MS, Boswell MV. Fentanyl transdermal system overdose secondary to cutaneous hyperthermia. Anesth Analg. 1993; 77:390–1.

22. Newshan G. Heat-related toxicity with the fentanyl transdermal patch. J Pain Symptom Manage. 1998; 16:277–8.

23. Frolich MA, Giannotti A, Modell JH. Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg. 2001; 93:647–8.

24. Adams AP, Pybus DA. Delayed respiratory depression after use of fentanyl during anaesthesia. Br Med J. 1978; 1:278–9.

25. Holzer P, Ahmedzai SH, Niederle N, et al. Opioid-induced bowel dysfunction in cancer-related pain: causes, conse-quences, and a novel approach for its management. J Opioid Manag. 2009; 5:145–51.

26. Stone P, Minton O. European Palliative Care Research col-laborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus? Palliat Med. 2011; 25:431–41.

27. McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003; 4:231–56.