• Kyriaki Pistevou-Gompaki, Vassilis E Kouloulias, Charalambos Varveris, Kyriaki Mystakidou, Grigoris Georgakopoulos, Nikos Eleftheriadis, Nikos Gompakis, and John Kouvaris.
• Department of Radiation Oncology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece. pipnely@yahoo.com
• Curr Med Res Opin. 2004 Jan 1;20(2):159-63.

ObjectiveTo compare the effects of providing analgesia with either transdermal fentanyl (TTS-fentanyl) or paracetamol and codeine (P/C) in addition to radiotherapy in patients with metastatic bone pain.MethodsIn a prospective study, 26 patients with radiologically confirmed bony metastases received radiotherapy (R/T). They were randomised to receive either 500 mg paracetamol and 30 mg codeine four times per day (P/C group), or transdermal fentanyl patches delivering 25 microg fentanyl/h (TTS-fentanyl group). Pain was assessed using visual analogue pain ratings (VAS) and the Greek Brief Pain Inventory (G-BPI) questionnaire administered before R/T and after 3 months.ResultsData were available from 24 eligible patients. Use of TTS-fentanyl was associated with significantly superior pain relief. Mean VAS fell from 7.0 to 1.1 with TTS-fentanyl and from 8.3 to 4.3 with P/C, p< 0.01. The TTS-fentanyl group also showed significantly greater improvements of important G-BPI domains including global quality of life, pain, and physical, cognitive, and role functioning, than the P/C group (p< 0.01). Four patients receiving TTS-fentanyl and three receiving P/C reported severe nausea/vomiting.ConclusionsTransdermal fentanyl combined with R/T was more effective in reducing metastatic bone pain and resulted in greater improvements in quality of life than paracetamol and codeine.

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