目的：本研究主要是探討吩坦尼穿皮貼片劑(transdermal fentanyl)於治療頭頸部癌症病人因同步化學放射治療所引發的嚴重口腔粘膜炎疼痛時，其效果和安全性的評估。材料與方法：本研究之主要對象為被診斷為頭頸部癌症並以同步化學放射治療的病人。當患者於治療過程中產生嚴重的口腔黏膜炎疼痛（即numeric rating scale [NRS]≧7）且無法以非類固醇抗發炎劑(nonsteroid anti-inflammatory drugs)及類固醇藥膏達到控制時，會給予吩坦尼穿皮貼片劑25μg/h。其後每一個星期會做疼痛強度的評估，如果NRS仍大於7分，則再給予吩坦尼穿皮貼片劑25μg/h一片。次外，每星期會根據Common Toxicity，Criteria (CTC) Version 2.0記錄因吩坦尼穿皮貼片劑造成的副作用。結果：自2002年10月至2003年3月期間，共有21位男性及1位女性頭頸部癌症並接受同步化學放射治療之病患被收入至此研究中。平均NRS在使用吩坦尼穿皮貼片劑一週後由原來的7.65±0.99（基準值）降至3.9±1.29。而在第五週時，平均NRS雖上升到了4.79±1.18，但仍有意義的低於基準值(p=0.003)。達到適當的疼痛控制劑量分別為，25μg/h有15人，50μg/h有5人，100μg/h則有1人。一位患者因為無法忍受的皮膚疹子及嘔吐而在第二週時停止使用吩坦尼穿皮貼片劑。其它並沒有發現呼吸抑制、意識改變，或者第三或第四級的腸胃道副作用。結論：吩坦尼穿皮貼片劑對於控制頭頸部癌症病人因同步化學放射治療所造成的嚴重口腔粘膜炎疼痛是有效且安全的。吩坦尼穿皮貼片亦減少了這些吞嚥疼痛或吞嚥困難的病人吞食藥物的需要性，同時也減少了調整傳統止痛藥物所需的時間。未來需要更大型的臨床隨機研究以再評估吩坦尼穿皮貼片劑對於口腔粘膜炎疼痛的效價和安全性。

Purpose: This prospective, longitudinal study was to evaluate the efficacy and the safety of using TTS-fentanyl for severe oral mucositis pain induced by concurrent chemoradiotherapy (CCRT) in head and neck cancer (HNC) patients. Materials and Methods: Patients diagnosed as HNC and scheduled for concurrent chemoradiotherapy were eligible for this study. TTS-fentanyl was given with the initial dose of 25 μg/h when severe mucositis pain (numeric rating scale [NRS]≧7) occurred in spite of nonsteroid anti-inflammatory drugs (NSAID) and topical steroidal ointment use. The pain intensity was assessed every week and if severe pain persisted, another dose of 25 μg/h TTS-fentanyl was given. The adverse effects were recorded every week according to Common Toxicity Criteria (CTC) Version 2.0. Results: From October 2002 to March 2003, 21 male and 1 female receiving CCRT with HNC were recruited to this study. The mean NRS for pain significantly decreased from 7.65±0.99 (baseline) to 3.9±1.29 within the first week. In the fifth week, the NRS raised to 4.79±1.18 but was still lower than the baseline (p=0.003). The sufficient analgesia was achieved in 15 cases with a dose of 25 μg/h, in 5 cases with a dose of 50 μg/h, and in 1 case with a dose of 100 μg/h. One patient withdrew the TTS-fentanyl due to intolerable skin rash and vomiting in the second week. Besides, no one developed respiratory depression, mental clouding, or grade Ⅲ/IV gatrointestinal toxicities. Conclusion: TTS-fentanyl is effective and safe in the treatment of mucositis-induced pain which is resistant to NSAID in HNC patients receiving CCRT. TTS-fentanyl also spares the need to swallow pain killers in these patients suffering from odynophagia and/or dysphagia, as well as the time for titration of conventional analgesic drugs. Further larger series with randomized setting is warranted to evaluate the efficacy and safety of TTS-fentanyl for oral mucositis pain.