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KMID : 0338420100250030337
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The Korean Journal of Internal Medicine
2010 Volume.25 No. 3 p.337 ~ p.340
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High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma
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Kim Jung-Han
Kim Mi
Sung Chong-Won
Kim Hyeoung-Su
Jang Hyun-Joo
Shin Young-Chul
Jung Joo-Young
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Abstract
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We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 μg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 μg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain.
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KEYWORD
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Fentanyl, Neoplasms, Pain, Cholangiocarcinoma
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