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Is Fentanyl Safe for Chronic Back Pain Management?

Fentanyl Patches and Other Fentanyl Experiences - Their Side Effects


Updated November 27, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Fentanyl is a member of the narcotic opiate analgesic class of pain medications and is used to treat back pain and cancer pain. When compared with other drugs in its class, fentanyl often leads the pack - by far and away - in terms of the number of prescriptions written for pain patients.

Unfortunately, this is true even though research in general does not bear out many manufacturers’ claims that the drug is effective in relieving moderate to severe pain.

Quick Intro to Fentanyl

Fentanyl is a rapid response, short acting opioid; your doctor may prescribe this drug for the times when your round the clock narcotic opioid (not fentanyl) fails to control breakthrough pain. Fentanyl is about 100 times stronger than morphine, and it is thought to penetrate the central nervous system much faster than morphine.

As an opioid, fentanyl works by changing the way your nervous system responds to pain signals.

You may have first hand experience with (or have heard about) the Fentanyl patch, lolipop or the buccal tab (or spray). These are some of the various ways Fentanyl available might be administered to people dealing with back pain.

Related: Routes of Administration

Fentanyl trade names include, but are not limited to, the Duralgesic (patch), the Actic (lolipop) and the Fentora buccal (tab).

Fentanyl Side Effects - Addiction

Like all narcotic pain killers, a controversial side effect of fentanyl is the risk for drug addiction. The NIH confirms this statement, saying that although experts don’t fully understand why, abusing narcotic pain killers and other prescription drugs can and does lead to addiction. They say one reason may be that a subset of doctors are prescribing more drugs than ever before. How many? It's that 80-20 rule: About 20% of doctors prescribe 80% of all the opioid medications, according to the CDC.

This is just conjecture (mine), but fentanyl's extra strength could account for the increased number of prescriptions these days. Perhaps many in that 20% of prescribing doctors group feel more pain relief is always better, even if it means ignoring potential side effects, dangers and what the evidence says about how well the drug does its job.

Public Relations - Not Necessarily Fact - Often Guides Doctors

Whether the above is true or not, another reason for increased fentanyl prescriptions may be the generous amounts of public relations aimed at doctors talking up the supposed safety and effectiveness of opioids such as fentanyl.

"There is a lot of advocacy out there reassuring doctors that the risk for addiction is not so bad," says Dr. Andrew Kolodny, President of the advocacy group called Physicians for Responsible Opioid Prescribing. (Physicians for Responsible Opioid Prescribing aims to reduce death and disease resulting from opioid prescribing as well as to promote cautious, safe, responsible opioid prescribing practices among medical doctors.)

Kolodny strongly believes these doctors (and their patients) are not getting all the facts.

The CDC supports Kolodny’s assertions. It reports that 3 out of 4 prescription drug over dose cases are caused by narcotic pain killers - the drug class to which fentanyl belongs.

Related: Prescription Opioid Blog Post: Are patients labeled by the system as "drug seeking" really substance abusers?

Prescription Narcotic Overdose Deaths - Who’s Responsible?

Not only that, but the CDC reports that since 1999 the increase in the number of deaths due to prescription drug overdose corresponds with the 300% rise in opioid sales for the same time period. The CDC also reports almost 15,000 deaths prescription drug related deaths in 2008, which outnumbered the deaths from heroine and cocaine combined.

Fentanyl, along with other opioids are on the NIH’s list of commonly abused drugs. These narcotics are classified by the National Institute on Drug Abuse as Schedule II drugs, which means they have a high potential for misuse. Schedule II drugs are only available by an nonrefillable prescription and have been purposely made more complicated to order than non Schedule II drugs.

In recent years a number of Fentanyl patch lots have been recalled by more than one manufacturer, but not before they reportedly caused some overdose deaths. Problems with the recalled lots included leaking packages and too quick release of the active ingredient in the medication.


From Occasional Use of Low Dose Narcotic Pain Killers to Major Public Health Issue - How Did This Happen?

As I indicated above, use of opioids to treat non-cancer (and cancer) pain has increased dramatically in the last 20 years. Horvath, Romero-Sandoval and De Leo, authors of "Glial Modulation in Pain States: Translation into Humans”, which was published in the book entitled Translational Pain Research: From Mouse to Man by Frontiers in Neuroscience in 2010, say the combination of the growing awareness of pain as an under treated phenomenon with stepped up marketing on the part of pharmaceutical companies is largely responsible. They say that in 1986 researchers Portenoy and Foley produced a landmark study that found low dose opioids relieved pain in 38 people. After that, they said, doctors started prescribing opioids for pain, and the rest is history. (Unfortunately, it’s now a major public health problem, as well.)

Horvath, Romero-Sandoval and De Leo reported that although the opioids in the landmark study led to pain relief for patients, the narcotics did nothing to help the patients get back to work or to increase physical functionality.

According to Horvath, Romero-Sandoval and De Leo, after the Portenoy and Foley landmark study was published, but before guidelines for safe and effective ways to prescribe opioids had been created (i.e. between the years 1990 and 1996), the medically related use of fentanyl increased by a whopping 1168%. Once the guidelines were published in 1997, by the way, medical prescriptions for fentanyl continued to increase - by 151.2%. Prescribed use of narcotics for pain relief continues to increase, the CDC says.

Pharmaceutical companies are (and have been) in an excellent position to sell opioid pain medications such as fentanyl, to many, many people, including those who are placed at risk of addiction, overdose and death because of the drug, Kolodny informs me.

Related: Prescription Drug Overdoses Blamed For High Number of Overdose Deaths


Horvath RJ, Romero-Sandoval EA, De Leo JA. Glial Modulation in Pain States: Translation into Humans. Translational Pain Research: From Mouse to Man. Boca Raton, FL: CRC Press; 2010. Chapter 9. http://www.ncbi.nlm.nih.gov/pubmed?term=opioid+therapy+for+chronic+pain+ballantyne+fentanyl&cmd=DetailsSearch

Commonly Abused Prescription Drugs Chart. National Institute of Drug Abuse. NIH webiste. Last Updated Oct 2011. http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-prescription-drugs-chart

Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999--2008. Morbidity and Mortality Weekly. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w Report (MMWR). November 4, 2011 / 60(43);1487-1492

Prescription Painkiller Overdoses in the US. Centers for Disease Control and Prevention website. Accessed November 2012. http://www.cdc.gov/Features/Vitalsigns/PainkillerOverdoses/

Policy Impact: Prescription Painkiller Overdoses. Centers for Disease Control and Prevention website. Accessed November 2012. http://www.cdc.gov/HomeandRecreationalSafety/rxbrief

De Luigi, Arthur J., DO. Director, Sports Medicine, MedStar National Rehabilitation Network. Washington, D.C. Email Interview. November 2012.

Kolodny, Andrew. President, Physicians for Responsible Opioid Prescribing. Phone Interview. November 2012.

DURAGESIC (fentanyl) patch Janssen Pharmaceuticals, Inc. Daily Med website. Accessed November 2012. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d7aade83-9e69-4cd5-8dab-dbf1d7b89bb4#nlm34067-9

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