CSP provides new guidance on fentanyl patches in physiotherapy practice

The CSP has published guidance for members who treat patients who wear transdermal fentanyl patches, which are prescribed to treat severe pain.


The guidance advises monitoring hydrotherapy patients who wear transdermal patches

The document aims to increase awareness among physiotherapists about potential risks associated with the patches.

It includes a recommendation that physios should carefully monitor patients who wear transdermal patches while having aquatic hydrotherapy.

Information currently provided by the manufacturer of the patches says patients should not expose the patches, or the skin around them, to direct heat sources. These could include electric blankets, heat lamps, saunas and hot tubs.

It also advises that they should avoid sunbathing, taking hot baths and physical activity that could raise skin temperature.

Guidance on aquatic physiotherapy

Hydrotherapy pools and aquatic physiotherapy are not mentioned in the supplier’s information. This has led to concerns among some CSP members that an increased body temperature associated with exercising in hydrotherapy pools may pose a risk for patients wearing the patches.

The society’s guidance advises members to report any adverse effects that patients who wear a transdermal patch experience, while exercising or having aquatic physiotherapy, to the Medicines and Healthcare products Regulatory Agency using their Yellow Card reporting scheme.

It also emphasises that

  • physios who treat patients who wear a patch must be aware of the signs of opioid overdose, such as shallow breathing, tiredness and an inability to think, walk or talk normally
  • physios should check a patient’s drug history for transdermal patch use before they participate in aquatic physiotherapy or intense exercise programmes
  • patients who are prescribed patches should be provided with directions for safe use, including the risks of raised temperature

Physios need to be mindful

CSP professional advisor Pip White said: ‘We have developed this guidance to help members understand the risks that may be involved and how they can manage them.

‘It will be useful for members who may prescribe fentanyl patches to patients in the future and those already providing treatment to patients using them.’

Dave Baker, an independent prescribing physio and chair of the Association of Chartered Physiotherapists in Orthopaedic Medicine and Injection Therapy, helped review the guidance.

He told Frontline: ‘This is a good example of the importance of physiotherapists being made aware of potential medicines management issues, in particular where there may be adverse interactions or consequences relating to medicines and physiotherapy treatments.

‘Physiotherapists need to be mindful of these issues. With a growing number of physiotherapists trained as prescribers it’s vital that we seek to highlight possible risks and disseminate this information in order to improve patient safety.'

Author: Robert Millett

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