DOI QR코드

DOI QR Code

A Case of Successful Management of Lung Cancer Pain Using Ultrahigh-dose Fentanyl Patch

  • Kim, Soo-Ok (Department of Internal Medicine, Seonam University Medical School) ;
  • Kim, Min-Jee (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kwon, Yong-Soo (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung-Chul (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Ban, Hee-Jung (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Oh, In-Jae (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Kyu-Sik (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Young-Chul (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2010.02.19
  • Accepted : 2010.03.02
  • Published : 2010.05.30

Abstract

A 55-year old woman with advanced stage non-small cell lung cancer was admitted to hospital for the management of severe chest pain, which measured 7 out of 10 on a numerical rating scale (NRS). Despite palliative radiation and the application of multiple epidural blocks, she continued to experience severe cancer pain. We gradually increased the dose of transdermal fentanyl patches from $500{\mu}g/hr$ to $3,650{\mu}g/hr$, for 3 months without any significant side effects. Concomitantly, adjuvant therapy with antidepressants and anticonvulsants were added, decreasing the patient's pain to NRS 3~4 down from 7. After being transferred to a hospice clinic, her chest pain was well-controlled below NRS 4 by means of strong opioid medications, including the highest dose of transdermal fentanyl $4,050{\mu}g/hr$ for more than 16 months.

Keywords

References

  1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: adult cancer pain V.1.2009 [Internet]. Fort Washington: National Comprehensive Cancer Network; 2009 [cited 2010 Feb 16]. Available from: http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf.
  2. Potter J, Higginson IJ. Pain experienced by lung cancer patients: a review of prevalence, causes and pathophysiology. Lung Cancer 2004;43:247-57. https://doi.org/10.1016/j.lungcan.2003.08.030
  3. Stjernsward J, Colleau SM, Ventafridda V. The World Health Organization Cancer Pain and Palliative Care Program: past, present, and future. J Pain Symptom Manage 1996;12:65-72. https://doi.org/10.1016/0885-3924(96)00109-1
  4. Kress HG, Von der Laage D, Hoerauf KH, Nolte T, Heiskanen T, Petersen R, et al. A randomized, open, parallel group, multicenter trial to investigate analgesic efficacy and safety of a new transdermal fentanyl patch compared to standard opioid treatment in cancer pain. J Pain Symptom Manage 2008;36:268-79. https://doi.org/10.1016/j.jpainsymman.2007.10.023
  5. Menahem S, Shvartzman P. High-dose fentanyl patch for cancer pain. J Am Board Fam Pract 2004;17:388-90. https://doi.org/10.3122/jabfm.17.5.388
  6. Radbruch L, Elsner F. Clinical experience with transdermal fentanyl for the treatment of cancer pain in Germany. Keio J Med 2004;53:23-9. https://doi.org/10.2302/kjm.53.23
  7. Seamans DP, Wong GY, Wilson JL. Interventional pain therapy for intractable abdominal cancer pain. J Clin Oncol 2000;18:1598-600. https://doi.org/10.1200/JCO.2000.18.7.1598
  8. Ryu JS, Kim SH, Um UH, Cho JH, Kwak SM, Lee HL. Successful treatment with high dose transdermal fentanyl patch for severe cancer pain in a patient with lung cancer. Tuberc Respir Dis 2007;62:140-3. https://doi.org/10.4046/trd.2007.62.2.140