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Transdermal Fentanyl for Severe Osteoarthritis
This opioid is a treatment option for patients with severe knee or hip osteoarthritis, but side effects are common.
Many patients with painful osteoarthritis cannot tolerate nonsteroidal anti-inflammatory drugs (NSAIDs), have contraindications to NSAIDs, or get inadequate pain relief from NSAIDs or acetaminophen. In this industry-sponsored international study, researchers examined the efficacy of opioid therapy with transdermal fentanyl for patients with moderate-to-severe pain caused by hip or knee osteoarthritis. All patients were thought to require joint replacement and were awaiting surgery, had refused surgery, or had medical contraindications to surgery.
About 400 patients were randomized to receive transdermal fentanyl patches (25 µg every 3 days, titrated to a maximum of 100 µg, if needed) or placebo patches. Only half of the patients completed the study: Fentanyl recipients were less likely than placebo recipients to withdraw because of lack of efficacy (7% vs. 33%) but were more likely to withdraw because of adverse events (27% vs. 10%). In an intent-to-treat analysis, pain relief was significantly greater in the fentanyl group than in the placebo group: The mean visual analog pain score (range, 0–100) decreased from 73 to 50 with fentanyl and from 73 to 55 with placebo.
Comment: These findings establish transdermal fentanyl as a treatment option for patients with severe knee or hip osteoarthritis. However, the average effect was not dramatic, owing to a substantial placebo effect and a high dropout rate because of side effects (especially nausea, vomiting, somnolence, and dizziness).
— Allan S. Brett, MD
Published in Journal Watch General Medicine July 4, 2006
Citation(s):
Langford R et al. Transdermal fentanyl for improvement of pain and functioning in osteoarthritis: A randomized, placebo-controlled trial. Arthritis Rheum 2006 Jun; 54:1829-37.
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- o/a severe pain
steve gibbons, n/a, 17 Apr 2009 1:42 AM EST
i read this whilst lying in bed with severe pain in both legs through o/a....it is only midday and i... [more]
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