• Davide Tassinari, Fabrizio Drudi, Marta Rosati, and Marco Maltoni.
• Department of Oncology, City Hospital, Rimini, Italy. dtassinari@rimini.com
• Palliat Med. 2011 Jul 1; 25 (5): 478-87.

BackgroundTo assess the role of transdermal opioids as a front-line approach to moderate to severe cancer pain.MethodsA 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.ResultsThirteen 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.ConclusionsThe 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.

12 keywords...

hide…