High-dose fentanyl patch for cancer pain.

OBJECTIVE To describe a successful experience with a high dose (1000 microg/hr) of transdermal fentanyl for cancer pain relief. CASE REPORT A 62-year-old man suffering from rectal carcinoma was treated by our home care hospice unit during his last 3.5 months of life. At admission to our home care unit, he suffered mostly from severe anal pain (verbal pain scale of 10/10) due to advanced disease. He was then on 150 microg/hr transdermal fentanyl. Adjuvant therapy with amitriptyline 50 mg/day and dexamethasone 4 mg/day was added, but it did not relieve his pain. The dose of transdermal fentanyl was increased gradually to 1000 microg/hr with good pain control (verbal pain scale of 1 to 4/10 most of the time). Before his death, he was mentally alert with good pain control. CONCLUSIONS High doses of transdermal fentanyl (1000 microg/hr; 10 patches) should be considered for pain relief in cancer patients.