Summary
Background. Abdominal pain is the dominant symptom in 50–75% of patients with chronic pancreatis, often requiring opioid analgesics. Fentanyl, a potent synthetic opioid, can be administered percutaneously at a constant dose and is claimed to have fewer systemic side effects.
Aim. To evaluate transdermal fentanyl plaster versus sustained release morphine tablets as analgesic treatment of painful chronic pancreatitis.
Methods. In an open randomized crossover trial, 18 patients were included. The treatment period was 4 wk for each drug. All patients had immediate-release morphine tablets as rescue medication.
Results. The dosage of transdermal fentanyl had to be increased on average 50% over that indicated by the manufacturer. When this was done and rescue medication was secured, no difference between the two drugs in primary endpoint or patient preference was observed. There was also no difference in the secondary endpoints, pain control, and quality of life. However, skin side effects, mostly mild, occurred in 44% of the patients during treatment with transdermal fentanyl, and the mean daily dose of immediate release morphine was significantly higher during the transdermal fentanyl period than during the sustained-release morphine period (30.7 mg vs. 14.7 mg [p<0.01]).
Conclusion. When given in an appropriate dose, transdermal fentanyl might be useful for treatment of some patients with painful chronic pancreatitis, e.g., when tablet ingestion is difficult. However, the dosage often has to be increased above that recommended by the manufacturer. The need of rescue morphine is considerable and skin side effects often occur. Transdermal fentanyl is, therefore, not the ideal first-choice analgesic in patients with painful chronic pancreatitis.
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References
Pedersen NT, Andersen BN, Pedersen G, Worning H. Chronic pancreatitis in Copenhagen. A retrospective study of 64 consecutive patients. Scand J Gastroenterol 1982; 17: 925–931.
Jansen JB, Kuijpers JH, Zitman FJ, Van Dongen R. Pain in chronic pancreatitis. Scand J Gastroenterol-Suppl 1995; 212: 117–125.
Ammann RW, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis. Gastroenterol 1999; 116: 1132–1140.
Thorsgaard Pedersen N, Worning H. Chronic pancreatitis. Scand J Gastroenterol 1996; 216: 52–58.
Ebbehøj N, Borly L, Bülow J, Henriksen JH, Heyeraas KJ, Grønvall Rasmussen S. Evaluation of pancreatic tissue fluid pressure measurements intraoperatively and by sonographically guided fine-needle puncture. Scand J Gastroenterol 1990; 25: 1097–1102.
Rolny P, Ärlebäck A, Funch-Jensen P, Kruse A, Järnerot G. Clinical significance of manometric assessment of both pancreatic duct and bile duct sphincter in the same patient. Scand J Gastroenterol 1989; 24: 751–754.
Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterol 1988; 94: 1459–1469.
Novis BH, Bornman PC, Girdwood AW, Marks IN. Endoscopic manometry of the pancreatic duct and sphincter zone in patients with chronic pancreatitis. Dig Dis Sci 1985; 30: 225–228.
Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Gastroenterology 1984; 86: 820–828.
Keith RG, Keshavjee SH, Kerenyi NR. Neuropathology of chronic pancreatitis in humans. Can J Surg 1985; 28: 207–211.
Ebbehøj N, Borly L, Madsen P, Svendsen LB. Pancreatic tissue pressure and pain in chronic pancreatitis. Pancreas 1986; 1: 556–558.
Jalleh RP, Aslam M, Williamson RCN. Pancreatic tissue and ductal pressures in chronic pancreatitis. Br J Surg 1991; 78: 1235–1237.
Bradley EL. Pancreatic duct pressure in chronic pancreatitis. Am J Surg 1982; 144: 313–316.
Sørensen HT, Rasmussen HH, Møller Petersen JF, Ejlersen E, Hamburger H, Olesen F. Epidemiology of pain requiring strong analgesics outside hospital in a geographically defined population in Denmark. Dan Med Bull 1992; 39: 464–467.
The Copenhagen Pancreatitis Study Group. Copenhagen pancreatitis study. Scand J Gastroenterol 1981; 16: 305–312.
Donner B, Zenz M, Tryba M, Strumpf M. Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain. Pain 1996; 64: 527–534.
Donner B, Zenz M. Transdermal fentanyl: a new step on the therapeutic ladder. Anticancer Drugs 1995; 6 Suppl 3: 39–43.
Roy SD, Flynn GL. Transdermal delivery of narcotic analgesics: pH, anatomical, and subject influences on cutaneous permeability of fentanyl and sufentanil. Pharm Res 1990; 7: 842–847.
Mather LE. Clinical pharmakokinetics of fentanyl and its newer derivatives. Clin Pharmacokinet 1993; 8: 422–446.
Wuster M, Schultz R, Herz A. The direction of opioid agonists towards micro-, delta- and epsilon-receptors in the vas deferens of the mouse and rat. Life Sci 1980; 27: 163–170.
Stanley TH, Webster L. Anaesthesia requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepam-oxygen anaesthesia in man. Anesth Analg 1978; 57: 411–416.
Hall GM. Fentanyl and the metabolic response to surgery. Br J Anaesth 1980; 57: 250–254.
Jeal W, Benfield P. Transdermal fentanyl. Review of its pharmacological properties and therapeutic efficacy in pain control. Drugs 1997; 53: 109–138.
Janssen Pharmaceutica Belgica. Recommended Durogesic dose based upon daily morphine dose. From directions for use enclosed the Durogesic packet. Janssen Pharmaceutica 1994.
Bjorner JB, Damsgaard MT, Watt T, Groenvold M. Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 1998; 51: 1001–1011.
Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P. The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 1998; 51: 991–999.
Ware JEJ, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51: 903–912.
Zenz M, Donner B, Strumpf M. Withdrawal symptoms during therapy with transdermal fentanyl (fentanyl TTS)? J Pain Symptom Manage 1994; 9: 54,55.
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Niemann, T., Madsen, L.G., Larsen, S. et al. Opioid treatment of painful chronic pancreatitis. International Journal of Pancreatology 27, 235–240 (2000). https://doi.org/10.1385/IJGC:27:3:235
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DOI: https://doi.org/10.1385/IJGC:27:3:235