I freely admit I'm a Myth Buster junkie--for those who don't know what I'm talking about, Myth Busters is a cable TV show where two guys go about proving or disproving myths from movies and everday life. As the hospice and palliative care movement is moving toward speciality status, it is important to scrutinize our clinical practice for our own myths. Over the next few weeks and months I will post some of my favorite pet peeves that permeate the world of end-of-life care. Now, if anyone has any hard data to prove that these myths are true--by all means come forward.
First on my hit list is oft repeated idea that transdermal fentanyl (Duragesic) is ineffective in cachectic patients due to the reduced body fat. Yes, it is true that Transdermal Fentanyl is aborbed across the skin into the fat and the fat serves as a depot for the slow release into the blood stream. But, I have searched high and low in the medical literature and can find no data that supports the idea that cachexia leads to inadequate pain control with this product. I found a one sentence statement in a respected palliative care textbook stating this idea as fact, with no supporting reference; I contacted the author who admitted that it was a mistake to include the statement as there was no evidence. So there it is--if you have evidence or can point me in the right direction, please come forward; otherwise, I will consider the fentanyl-fat connection to be a palliative care myth.
Disclaimer: I have NO financial or other relationship with Janssen Pharmaceuticals, the maker of Duragesic Transdermal System.
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