Transdermal opioids as front line treatment of moderate to severe cancer pain: a systemic review.

Category Broad synthesis
JournalPalliative medicine
Year 2011
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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.
Epistemonikos ID: fc8a98ffb3d4541fd8351b49a0a43d352589d466
First added on: Jan 07, 2015