Psychiatry and Clinical Psychopharmacology

Transdermal fentanyl dependency in the treatment of cancer pain: a case report

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S156-S157
Read: 551 Published: 18 February 2021

Fentanyl, a drug with high affinity to μ - receptors, is a selective and synthetic opioid agonist. It has 75-100 times more potent pain relieving effect than that of morphine. Available administration ways are oral, intravenous, epidural, transmucosal, intranasal and trandermal. Painkiller effects of fentanyl patches are as strong as opioids. They are more preferable in cancer treatment due to their relatively low side effects. 12.5, 25, 50, 75, 100 mcg/h strengths of these patches are available. In literature, three cases are reported about addiction of fentanyl skin patch. In our case, in spite of remission of cancer and relieving of pain, patch use has continued and addiction occurred. Our aim is to draw the attention to the problem of unnecessary and inappropriate long-term use of fentanyl skin patches for management of cancer related pain. A 47 years old female patient was admitted to our clinic with complaints of long-term use of fentanyl skin patches and failing to quit, along with depressive symptoms. 4 years ago, due to breast cancer, she had bilateral mastectomy operation and chemotherapy was started. Afterwards, she visited pain clinic in anesthesia unit due to fatigue and body aches. 25 mcg/h fentanyl transdermal skin patch was initiated. One year later, patient was admitted to rheumatology unit with joint effusion and widespread muscle pain. 3 years ago, she was diagnosed with connective tissue infection and 200 mg hydroxychloroquine sulfate, 4 mg prednisolone and 60 mg acemetacin were started. Patient benefited from these drugs. Despite doctors reported cancer and connective tissue disease were in remission and pain was not expected anymore, yet continued to prescribe fentanyl upon patient’s request. Due to the patient’s fatigue and body aches fentanyl dose was increased to 50 mcg/h. After using it for 6 months at the dose of 50 mcg/h, it is reduced to 25 mcg/h by pain clinic. Patient tried to quit fentanyl according to doctor’s recommendations, but failed. During these attempts, she experienced withdrawal symptoms and was unable to do household chores. Her hospital admissions became frequent. In our clinic, 30 mg/day duloxetine was started for her depressive symptoms. Fentanyl administration for patient was organized as 25 mcg/day once in every 3 days for first 2 weeks, once in every 4 days between 2 and 4 weeks and once in every 6 days between 4 and 6 weeks. During follow-up, duloxetine dose was increased to 60 mg/day and 150 mg of diclofenac sodium was added for the treatment of pain. The patient was recommended to continue duloxetine and regular follow-up examinations. Although transdermal fentanyl reported to be very low risk of addiction, in recent years increasing use in patients with chronic pain suggests that addiction could become more frequent. In our case, although the cancer pain was disappeared and connective tissue disease was in remission, fentanyl skin patch has continued to be prescribed. Our purpose of presenting this case, with proper training of professionals involved in the treatment of cancer pain for fentanyl prescription, possible future emergence of such addiction cases could be prevented.

EISSN 2475-0581