Tuberc Respir Dis.  2010 May;68(5):286-289.

A Case of Successful Management of Lung Cancer Pain Using Ultrahigh-dose Fentanyl Patch

• Kim SO
• Kim MJ
• Kwon YS
• Lim SC
• Ban HJ
• Oh IJ
• Kim KS
• Kim YC

Abstract

A 55-year old woman with advanced stage non-small cell lung cancer was admitted to hospital for the management of severe chest pain, which measured 7 out of 10 on a numerical rating scale (NRS). Despite palliative radiation and the application of multiple epidural blocks, she continued to experience severe cancer pain. We gradually increased the dose of transdermal fentanyl patches from 500 microgram/hr to 3,650 microgram/hr, for 3 months without any significant side effects. Concomitantly, adjuvant therapy with antidepressants and anticonvulsants were added, decreasing the patient's pain to NRS 3~4 down from 7. After being transferred to a hospice clinic, her chest pain was well-controlled below NRS 4 by means of strong opioid medications, including the highest dose of transdermal fentanyl 4,050 microgram/hr for more than 16 months.

Keyword

Lung Neoplasms; Chest Pain; Analgesics, Opioid

MeSH Terms

Analgesics, Opioid
Anticonvulsants
Antidepressive Agents
Carcinoma, Non-Small-Cell Lung
Chest Pain
Female
Fentanyl
Hospices
Humans
Lung
Lung Neoplasms
Analgesics, Opioid
Anticonvulsants
Antidepressive Agents
Fentanyl

Figure

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  Figure 1 (A) Chest X-ray shows haziness and pleural effusion in right lower lung field. (B) Chest CT scan shows an increased amount of multiloculated pleural effusion along right pleural space with nodular pleural thickening and enhancement, considered as aggravated pleural metastasis.

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  Figure 2 The simplified graph of the course of increasing fentanyl patch doses according to the patient's pain scale. IV morphine converted dose means all the oral and parenteral opioid equivalences, including fentanyl patch. NRS: numerical rating scale.

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  Figure 3 (A) At her discharge, over 36 patches of transdermal fentanyl 100 µg/hr were applied her skin from her trunk to both legs. (B) The patient could be enjoying light exercise such as ringtoss with applying multiple patches.

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