title: Transdermal opioids as front line treatment of moderate to severe cancer pain: a systemic review.
abstract: BACKGROUND
  To assess the role of transdermal opioids as a front-line approach to moderate to severe cancer pain.
  
  
  METHODS
  A systematic review of the literature was performed by two authors. An analysis of the level of evidence and risk/benefit ratio was performed for all of the selected trials. A combined analysis of the included studies to assess the level of evidence, risk/benefit ratio and strength of the recommendations was performed to determine the place of transdermal opioids in the treatment of cancer when compared with oral morphine.
  
  
  RESULTS
  Thirteen papers were included in the analysis. The level of evidence was considered low for transdermal opioids (without distinction between transdermal fentanyl and transdermal buprenorphine) or transdermal fentanyl, and very low for transdermal buprenorphine. The risk/benefit ratio was considered uncertain for both transdermal opioids (fentanyl and buprenorphine) considered together and transdermal fentanyl or buprenorphine alone. The strength of the final recommendations (using the GRADE system) was weak negative for transdermal opioids (transdermal fentanyl plus transdermal buprenorphine) and transdermal fentanyl, and strong negative for transdermal buprenorphine.
  
  
  CONCLUSIONS
  The use of slow release oral morphine probably remains the preferred approach for these patients, with the use of transdermal opioids to be reserved for selected patients.
authors.affiliation: Department of Oncology, City Hospital, Rimini, Italy. dtassinari@rimini.com
authors.forename: Davide
authors.initials: D
authors.lastname: Tassinari
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drudi
authors.forename: Marta
authors.initials: M
authors.lastname: Rosati
authors.forename: Marco
authors.initials: M
authors.lastname: Maltoni
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid