High-dose fentanyl patch for cancer pain of a patient with cholangiocarcinoma

Korean J Intern Med. 2010 Sep;25(3):337-40. doi: 10.3904/kjim.2010.25.3.337. Epub 2010 Aug 31.


We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 µg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 µg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain.

Keywords: Cholangiocarcinoma; Fentanyl; Neoplasms; Pain.

Publication types

  • Case Reports

MeSH terms

  • Administration, Cutaneous
  • Analgesics, Opioid / administration & dosage
  • Bile Duct Neoplasms / drug therapy*
  • Bile Ducts, Intrahepatic*
  • Cholangiocarcinoma / drug therapy*
  • Fentanyl / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy*
  • Pain / physiopathology
  • Pain Measurement


  • Analgesics, Opioid
  • Fentanyl