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Transdermal Fentanyl vs. Oral Morphine for Chronic Pain

Opioids have become accepted increasingly for treating selected patients with chronic noncancer pain. This multinational, randomized, open-label, crossover study involved 256 patients with chronic noncancer pain (mean duration, 9 years) who were receiving opioids, mainly morphine. The patients were randomized to receive a fentanyl patch or oral sustained-release morphine for 4 weeks; all patients were then switched to the other treatment for 4 weeks. The study was supported by the manufacturer of transdermal fentanyl.

Significantly more patients preferred fentanyl patches to morphine (65 percent vs. 28 percent), and significantly more patients judged their pain control to be good or very good with fentanyl than with morphine (35 percent vs. 23 percent). Quality-of-life scores were higher overall with fentanyl than with morphine, with significant differences for bodily pain, vitality, social functioning, and mental health. The proportion of adverse events was similar in the 2 groups (74 percent vs. 70 percent). More patients withdrew from the fentanyl group than from the morphine group (16 percent vs. 9 percent).

Comment: Because this study was not blinded, there may have been a bias toward a drug that patients assumed was "newer" than morphine. Nonetheless, both drugs provided reasonable pain relief. The results suggest that the dermal patch delivery system may be a preferred method of pain relief for many patients. At the time of publication, the full text of the original article was available at http://www.bmj.com/cgi/content/full/322/7295/1154 free of charge.

— KI Marton

Published in Journal Watch General Medicine June 5, 2001

Citation(s):

Allan L et al. Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. BMJ 2001 May 12 322 1154-1158.

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