title: High-dose fentanyl patch for cancer pain of a patient with cholangiocarcinoma.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea. harricil@hotmail.com
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Mi
authors.initials: M
authors.lastname: Kim
authors.forename: Chong Won
authors.initials: CW
authors.lastname: Sung
authors.forename: Hyeoung Su
authors.initials: HS
authors.lastname: Kim
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Jang
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Shin
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Jung
mesh_terms: D000279:Administration, Cutaneous; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000188:drug therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000188:drug therapy*; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl