Pain in RA
Transdermal Fentanyl for Treating Pain in RA
Berliner MN, Giesecke T, Bornhövd KD. Impact of transdermal fentanyl on quality of life in rheumatoid arthritis. Clin J Pain. 2007;23:530-534.
Abstract
Objectives: The purpose of the study was to investigate the effectiveness and tolerability of transdermal fentanyl in a treatment regimen in patients with RA.
Methods: Two hundred twenty-six patients (mean age 66) with severe pain caused by RA who had not previously been treated with transdermal fentanyl were included in this prospective, open-label study. Pain intensity, functional impairment, and well-being were documented prospectively for 30 days after treatment with transdermal fentanyl had been initiated. Patients evaluated pain on an 11-point numerical rating scale. Quality of sleep, daily and social functioning, and treatment satisfaction were rated using 5-point categorical rating scales. General well-being was assessed by the Marburg questionnaire.
Results: Adding transdermal fentanyl to the ongoing RA therapy reduced pain intensity significantly from 8.0 (7.82 to 8.18) to 4.0 (3.75 to 4.25). Mean functional impairment due to pain also decreased significantly from “severe” at the beginning to “mild to moderate.” Treatment with transdermal fentanyl also led to a significant improvement by approximately 1.5 units for all items in the Marburg questionnaire on general well-being. At the end of the study, nearly all patients were satisfied with the pain treatment. Transdermal fentanyl was generally well tolerated. The most frequent side effects were nausea (9.7%) and vomiting (7.1%).
Discussion: Patients with pain caused by RA improved in terms of pain intensity, sleep, function, and general well-being when transdermal fentanyl was added to the treatment regimen. Treatment satisfaction was high. Transdermal fentanyl also demonstrated good tolerability over a period of 30 days.
Commentary
Pain is a common symptom in RA, and many of those affected experience severe pain. Other common issues include sleep disturbance, activity impairment, and a decreased sense of well-being. The purpose of the study was to determine the effectiveness of transdermal fentanyl for reducing pain intensity and functional impairment and increasing feelings of well-being. Transdermal fentanyl continuously delivers fentanyl, a synthetic narcotic, through a patch applied to the upper torso; the patch is changed every 72 hours. While the dose varies with the individual, the generalized base recommended for all individuals as they begin treatment is 25 µg per hour (equivalent to approximately 2.5 mg of morphine/hour). This base dose can be raised by 25 µg per hour every 72 hours as needed, with recognition that 12 to 24 hours is required to reach peak plasma concentration and up to a week is needed to reach steady-state levels.1