Transdermal Fentanyl for Severe Osteoarthritis

Summary and Comment |
July 4, 2006

Transdermal Fentanyl for Severe Osteoarthritis

  1. Allan S. Brett, MD

This opioid is a treatment option for patients with severe knee or hip osteoarthritis, but side effects are common.

  1. Allan S. Brett, MD

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).

Citation(s):

Reader Comments (1)

steve gibbons

i read this whilst lying in bed with severe pain in both legs through o/a....it is only midday and i am bedbound with pain...i would dearly do anything for pain relief and wish more doctors would give serious thought to aiding people like me who have chronic pain but who havent got terminal illness...strong effective analgesia should be available for all who need it,the fears of addiction taking place should not be the primary issue when prescribing for chronic severe pain...quality of life should be first and foremost..Doctors please note.

Competing interests: None declared

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.