The aim of this study was to examine and compare the efficacy and safety of combining strong opioids (transdermal fentanyl) with weak opioids (codeine or tramadol) for the management of severe cancer pain. Forty six patients (25 male / 21 female) aged 42-80 years were studied. According to an eleven-grade numeric rating scale (NRS; 0 = no pain, 10 = severe pain), they all had severe steady pain intensity greater than 5 (NRS >5) despite treatment with weak opioids and adjuvant drugs, as proposed by the 2nd step of the World Health Organization (WHO) analgesic ladder, at the maximum tolerated doses.

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NSAIDs are widely used compounds in the management of several acute and chronic pain syndromes. NSAIDs induce their action by blocking the cyclooxygenase enzymes, cox-1 and cox-2, during the conversion of arachidonic acid to prostaglandins. Conventional NSAIDs inhibit both cox isoforms and are therefore at risk of serious complications as gastrointestinal irritation, postoperative bleeding, renal failure, water and sodium retention and hepatic failure.

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Gabapentin was tested as complementary analgesic in 25 cancer patients in whom pain was not sufficiently controlled by transdermal fentanyl. Neuropathic pain syndrome in these patients consisted of burning pain and allodynia. Gabapentin was administered at a dose of 648±206,4mg, while dosage of transdermal fentanyl was fixed (261±98,1μg/h).

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