Transdermal fentanyl for the treatment of pain caused by rheumatoid arthritis

This study evaluated transdermal fentanyl (TDF) for the treatment of pain from rheumatoid arthritis (RA) which was not adequately controlled by nonopioid analgesics and/or weak opioids. Following 1 week of optimization of current analgesic medication, patients (n=104) started 28-day treatment with 25 μg/h of TDF, with the option to up-titrate until adequate pain control was achieved. Metoclopramide was taken during the 1st week and as needed thereafter. Eighty-four patients completed the treatment phase, and 42 entered the 1-week tapering-off phase. The most frequently used maximum dose was 25 μg/h. The number of patients with pain control increased, particularly in the 1st week of treatment (33% to 77%), to 88% on day 28. From baseline to endpoint, there were reductions in pain (P<0.001), including in “pain right now” at 24 h, and in degree of pain (mean reduction from “severe” to “moderate”), improvements in function (majority of items in the Health Assessment Questionnaire) (P<0.001), and in quality of life (Short Form 36 physical P<0.001, mental P<0.05). Treatment was assessed favorably: ≥78% would recommend it. Transdermal fentanyl should be considered in treatment programs for patients with RA.