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.
Department of Radiation Oncology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece. pipnely@yahoo.com
Kyriaki
K
Pistevou-Gompaki
Vassilis E
VE
Kouloulias
Charalambos
C
Varveris
Kyriaki
K
Mystakidou
Grigoris
G
Georgakopoulos
Nikos
N
Eleftheriadis
Nikos
N
Gompakis
John
J
Kouvaris
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