Radiotherapy plus either transdermal fentanyl or paracetamol and codeine for painful bone metastases: a randomised study of pain relief and quality of life.
OBJECTIVE
To compare the effects of providing analgesia with either transdermal fentanyl (TTS-fentanyl) or paracetamol and codeine (P/C) in addition to radiotherapy in patients with metastatic bone pain.


METHODS
In a prospective study, 26 patients with radiologically confirmed bony metastases received radiotherapy (R/T). They were randomised to receive either 500 mg paracetamol and 30 mg codeine four times per day (P/C group), or transdermal fentanyl patches delivering 25 microg fentanyl/h (TTS-fentanyl group). Pain was assessed using visual analogue pain ratings (VAS) and the Greek Brief Pain Inventory (G-BPI) questionnaire administered before R/T and after 3 months.


RESULTS
Data were available from 24 eligible patients. Use of TTS-fentanyl was associated with significantly superior pain relief. Mean VAS fell from 7.0 to 1.1 with TTS-fentanyl and from 8.3 to 4.3 with P/C, p< 0.01. The TTS-fentanyl group also showed significantly greater improvements of important G-BPI domains including global quality of life, pain, and physical, cognitive, and role functioning, than the P/C group (p< 0.01). Four patients receiving TTS-fentanyl and three receiving P/C reported severe nausea/vomiting.


CONCLUSIONS
Transdermal fentanyl combined with R/T was more effective in reducing metastatic bone pain and resulted in greater improvements in quality of life than paracetamol and codeine.
Pistevou-Gompaki
Kyriaki
K
Department of Radiation Oncology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece. pipnely@yahoo.com
Kouloulias
Vassilis E
VE
Varveris
Charalambos
C
Mystakidou
Kyriaki
K
Georgakopoulos
Grigoris
G
Eleftheriadis
Nikos
N
Gompakis
Nikos
N
Kouvaris
John
J
D000082:Acetaminophen / Q000008:administration & dosage*; D000203:Activities of Daily Living; D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy*; D003061:Codeine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000532:radiotherapy; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric
D000700:Analgesics; D000082:Acetaminophen; D005283:Fentanyl; D003061:Codeine