PMID- 18038178
OWN - NLM
STAT- MEDLINE
DCOM- 20081003
LR  - 20211020
IS  - 0770-3198 (Print)
IS  - 0770-3198 (Linking)
VI  - 27
IP  - 5
DP  - 2008 May
TI  - Transdermal fentanyl improves pain control and functionality in patients with 
      osteoarthritis: an open-label Canadian trial.
PG  - 587-95
AB  - Current treatment guidelines advocate opioids for arthritis when standard 
      analgesics produce inadequate relief. Efficacy, adverse effects (AEs), dosing 
      regimens, physician expertise and patient preference influence treatment 
      selection. This study assessed transdermal fentanyl (TDF) as a treatment option 
      for osteoarthritis (OA) patients. This prospective, Canadian open-label, 8-week 
      trial assessed the efficacy and safety of TDF in patients with OA of hip or knee 
      with moderate-to-severe target joint pain inadequately controlled using weak 
      opioids. TDF was initiated at 25 mcg/h and titrated to optimal pain control. 
      Rescue acetaminophen 500 mg was allowed (maximum 4 g/day). The main endpoint was 
      improvement in pain control assessment rating (five rating categories); pain 
      intensity (0-10 numerical scale), functionality (WOMAC-OA Index), health-related 
      quality of life (SF-36 Health Survey) and global impression were also evaluated. 
      Eighty-one patients (61% female, mean age 60 years) were enrolled; 62 were 
      evaluable. All had failed on previous weak opioid therapy, primarily codeine or 
      codeine combinations. At treatment end, 65% rated pain control as improved (Pain 
      Control Assessment rating change >or=1 category; p<0.0001); mean change in pain 
      intensity was a reduction of greater than 2 (p<0.0001); almost 50% were 
      maintained on TDF 25 mcg/h with less than 1.3 g/day of rescue acetaminophen. At 1 
      month and end of treatment, changes in the SF-36 physical global scale and 
      individual sub-scores for the pain index and role-physical scales were highly 
      significant (p<0.0001). Improvement in functionality was noted at 1 month and at 
      end of treatment with significant reductions in total WOMAC score, individual 
      pain, stiffness and physical function sub-scores (p<0.0001). AEs causing 
      discontinuation (n=32) included nausea, dizziness and vomiting. Most 
      treatment-related AEs were mild to moderate in intensity. TDF improved pain 
      control, functionality and health-related quality of life in these patients. The 
      findings support current recommendations for use of opioids such as TDF as a 
      treatment option for a sub-population of patients with OA pain.
FAU - Choquette, Denis
AU  - Choquette D
AD  - Notre-Dame Hospital, Montreal, QC, Canada. denis.choquette.irm@videotron.ca
FAU - McCarthy, Timothy G
AU  - McCarthy TG
FAU - Rodrigues, Jude F N
AU  - Rodrigues JF
FAU - Kelly, Allan J
AU  - Kelly AJ
FAU - Camacho, Fernando
AU  - Camacho F
FAU - Horbay, G L A
AU  - Horbay GL
FAU - Husein-Bhabha, Farah A
AU  - Husein-Bhabha FA
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20071123
PL  - Germany
TA  - Clin Rheumatol
JT  - Clinical rheumatology
JID - 8211469
RN  - 0 (Analgesics, Opioid)
RN  - UF599785JZ (Fentanyl)
SB  - IM
CIN - Clin Rheumatol. 2008 Nov;27(11):1473-4. PMID: 18751754
MH  - Administration, Cutaneous
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics, Opioid/administration & dosage/adverse effects/*therapeutic use
MH  - Canada
MH  - Female
MH  - Fentanyl/administration & dosage/adverse effects/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Osteoarthritis, Hip/*drug therapy
MH  - Osteoarthritis, Knee/*drug therapy
MH  - Pain Measurement
MH  - Prospective Studies
MH  - Recovery of Function
MH  - Treatment Outcome
EDAT- 2007/11/27 09:00
MHDA- 2008/10/04 09:00
CRDT- 2007/11/27 09:00
PHST- 2006/12/20 00:00 [received]
PHST- 2007/09/17 00:00 [accepted]
PHST- 2007/09/13 00:00 [revised]
PHST- 2007/11/27 09:00 [pubmed]
PHST- 2008/10/04 09:00 [medline]
PHST- 2007/11/27 09:00 [entrez]
AID - 10.1007/s10067-007-0751-6 [doi]
PST - ppublish
SO  - Clin Rheumatol. 2008 May;27(5):587-95. doi: 10.1007/s10067-007-0751-6. Epub 2007 
      Nov 23.