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Got carcinoid cancer. Developed pain. Not getting relief by fentanyl patch. Effective medicine?

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Oncologist, Radiation
Practicing since : 2007
Answered : 526 Questions
Dear Doctor!
My husband has got cancer, rare one CARCINOID (in the small intestine). Lately he started to develop very bad pain, like spasms, coming and going (he is getting through chemo). Yesterday at 17.30 we put a prescribed patch of FENTANYLUM (25 mg). After 24 hours it still doesn't relieve the pain (supposed to be in 8 hours). I am looking for the painkiller to give in the mean time (you know, it's a weekend) and I am afraid of any interactions. I know I should avoid any Aspirin containing medicaments. What do you think about NOVALGINE? I tried already Nurofen, Spasmomen 40 mg, Panadol, Buscopan - don't help.
Would appreciate your advice.
Kind regards,
Posted Fri, 1 Mar 2013 in Cancer
Answered by Dr. Dipanjan Majumder 58 minutes later

Thanks for posting your query.

I can understand your concern. Can you please give some information as to understand his conditino better:
- Does he have other complains like facial flushing, sweating, diarrhea, shortness of breath, wheezing or asthma-like symptoms, fast heartbeat, unexplained weight gain, weakness, increased body and facial hair, high blood pressure and significant fluctuations in blood pressure
- It will be easier if treatment details can also be mentioned.
- Can you please mention whether the disease has been already metastasized or not.

In cancer pain management WHO analgesic ladder are followed. Here there are three steps of selection and strong OPIOIDS are used in ladder III.

As already fentanyl, which is an opioid analgesic, has been prescribed we may modify the dose for better effects. Commonly the dose can be increased upto 75 mcg/hr easily. It takes time for action.
If you need some immediate action you should offer your husband oral morphine. Discuss with your current doctor who can help you give a prescription for the same.

A word of advice: These drug should be used with proper premedication and proper dosing schedule.

I do not favour the use of Novalgin in a malignant background because, novalgin has the following side effects
-agranulocytosis , leucopenia , thrombocytopenia (blood related problem)
-asthmatic attacks, anaphylactic shock
-proteinuria / interstitial nephritis (kidney problem) , rashes

Hope I have answered your queries. I will be available for follow up.

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