Introduction
There is little consensus regarding the burden of pain in the UK, a systematic review of medical literature estimate that chronic pain affects between one third and one half of the UK population, adversely affecting their quality of life and resulting in lost working days1.
The government's Health Survey for England 2011 confirmed that chronic pain results in a significant financial burden to the NHS through increased GP and A&E appointments. It is also associated with other negative outcomes such as increased rates of depression and anxiety, job loss, reduced quality of life, impaired functioning and limitation of daily life. Patients suffering from chronic pain are less able to undertake normal every day activities such as work, school or housework, to retain their mobility and also their ability to look after themselves. It follows from this that the provision of effective pain control brings significant benefit to the lives of millions of people.2
Pain is a common symptom that at some point in time will affect everyone. It is a subjective experience and each patient will react to pain differently. This makes measuring and assessing pain more difficult. Pain has a protective role within the body making the individual aware that illness or injury is occurring or has occurred. Pain is usually classified according to its cause, timeframe or nature.
Fentanyl is an opioid analgesic with a high affinity for the μ (mu) opioid receptor. Fentanyl is approximately 100 times more potent than morphine and transdermal fentanyl is used as an effective alternative to oral morphine. Fentanyl is licensed for the treatment of chronic intractable pain of cancerous and non-cancerous origin. It can be administered parenterally, transdermally, transmucosally in the mouth/nasal cavity or sublingually; the choice of formulation is dependent upon the required onset of action. Transdermal administration will begin to have an effect within twelve hours whilst sublingual administration is quicker, having an effect within fifteen to thirty minutes.
This module will concentrate on pain and its management with the use of transdermal fentanyl.
OBJECTIVES
By the end of this module you will be able to:
- Describe how the body detects and transmits pain signals.
- Explain how fentanyl exerts its analgesic effect.
- Discuss when transdermal fentanyl is an appropriate choice of analgesic and where its use is inappropriate.
- Provide advice to patients and prescribers to ensure the safe and effective use of fentanyl patches.
- Work within the legal requirements associated with the storage, handling, prescribing and disposal of fentanyl.
- Convert doses of opioids to equivalent transdermal fentanyl doses.