A Evaluation Of The Clinical Benefits Of Switching From Morphine To Transdermal Fentanyl In Cancer Pain Patients

Morphine as the preferred first-line pain of moderate to severe cancer pain is widely used in clinical medicine for its efficiency, convenience, cost,security. Theoretically speaking, all the pains could be cured through increasing the dose with tolerable side effects that would lighten progressively during from three to seven days except constipation. But in clinical practice,some patients did not achieve pain control from morphine (for being insensitive to morphine, increasing in side effects as the dose increased gradually with/without analgesic effect). It is reported that switching from morphine to another Opioid would benefit for the patients. With The effectiveness of strong, absorption through skin instead of the digestive tract, avoiding the first pass metabolism of liver and so on, transdermal fentanyl is quite different from morphine.Therefore we prospectively evaluate the clinical benefits of switching from morphine to transdermal fentanyl in cancer patients with moderate and severe pain who did not achieve pain control from morphine. [Objective]:To prospectively evaluate the clinical benefits of switching from morphine to transdermal fentanyl in cancer patients with moderate and severe pain who did not achieve pain control from morphine.[Methods]:Between april2010and july2011, palliative care patients required treatment with oral morphine for pain control first. Non-responders (switchers) were patients who had either uncontrolled pain or unacceptable side effects on morphine and therefore required an alternative opioid,transdermal fentanyl Observe the effect and side effects respectively. Take the NRS score, QOL score,PAR rate and KPS score to assess the analgesic effect, quality life and life skills before and after the conversion. Describe the doses with the median. The data were analyzed by SPSS17.0software:Using t test to compare the patients’ scores of NRS、QOL、KPS before and after the conversion, Using Chi-square test to compare all patients’adverse reactions and PAR rate before and after the conversion. Describing and counting the all patients’medication compliance of the two drugs before and after the conversion.[Result]:1.70.3%(133/189) had a good response to morphine (responders).29.7%(56/189) did not respond to morphine. These nonresponders were switched to transdermal fentanyl (switchers), including31patients refusing to increase the dose for he/she can’t afford side effects,22with good analgesia effect but severe side effects,3patients don’t want to use morphine because it makes no sense although they have increased dose to3times.2.The doses of morphine of two groups are120mg(30-480) vs90mg(30-300), which is lower in the non-effect group.3. Of56patients,43(43/56,76.8%) achieved a successful outcome when switched to transdermal fentanyl. Overall successful pain control rate with minimal side effects was achieved in93.1%(176/189) of patients. The score of NRS decreases and PAR improves before and after conversion (P<0.05).The QOL score and the KPS score of patients were both higher after conversion (P <0.05).4.The side effects of the two drugs reduce obviously, especially in nausea, vomiting and constipation (P>0.05). But there is no significant different in dizziness before and after conversion (P<0.05).5.The doses of56patients are90mg(30-300)(morphine) vs75ug/h(12.5-250)(transdermal fentanyl), equivalent to150mg (30-500)(morphine), which means taking more doses after conversion, increasing about67%.6.85%(43/56) of the patients preferred transdermal fentanyl[Conclusions]: Switching from morphine to transdermal fentanyl is a good choice because of significantly improving pain control with better compliance when patients did not respond to morphine.