The effects of transdermal fentanyl on driving, cognitive performance, and balance in patients with chronic nonmalignant pain conditions

Objective. To evaluate driving performance, cognition, and balance in patients with chronic nonmalignant pain before and after the addition of transdermal fentanyl to their treatments. Design. Prospective, one-group pretest-posttest design. Setting. Outpatient pain center associated with a large, urban medical school. Interventions. Patients taking less than a 15-mg equivalent of oxycodone per day took baseline driving performance, cognitive, and balance tests. Transdermal fentanyl was initiated and titrated in 25-μg/hour increments, weighing benefits and side effects. At the end of a 1-month period, the achieved dose was maintained for another month. After they were stabilized for 1 month, patients repeated driving, cognitive, and balance tests. Results. Twenty three patients completed the study; three discontinued secondary to side effects. The median dose at the end of the titration period was 50 μg/hour (48%). No differences were found in driving simulation measures between the pretreatment and posttreatment periods. No decrements in cognitive performance were found. Improvements in visual motor tracking, visual memory, and attention were found during treatment with transdermal fentanyl. No differences in balance or body sway were found. Pain decreased over the course of treatment. Conclusions. The addition of transdermal fentanyl to a treatment regimen containing no opiates or small amounts of opiates for patients with chronic nonmalignant pain did not negatively affect their driving performances, reaction times, cognition, or balance. Future studies in this area are needed to guide treatment decisions.