Aim: Refractory cancer pain is a challenge for oncologists and pain physicians. All cancer patients with refractory pain are seen in the pain clinic and therapy is been decided in collaboration with the oncologists. TDS opioids are used but very often the patients are not comfortable. 
We are presenting a study where 30 patients with refractory pain who have been on TDS Fentanyl for few months with no satisfactory effect.
Method: This is an open label study of 30 patients with refractory  pain due to bone metastasis. On day one all patient were on TDS Fentanyl 50mcgr/h plus adjuvant analgesics. 
Pain scores were 7-9/10 VAS 
QoL scores were low (2-5/10)
PF (performance status) was 3-1/5
Prognosis was less than three months so the NHS could not grand these patients for a morphine pump.
Patients were divided in two groups.
Group one continued  the pain therapy with TDS Fentanyl up to 200mcgr/h.
Group two switched to TDS morphine (BUVERA) and reached 140mgr/h.
We valued: 1. Pain scores, 2 nausea, 3, vomiting, 
4 side effects,  5 constipation, 6 patient satisfactory and 7 QoL.
Results: There was no difference in QoL and PS in the two groups.
There was a small statistical difference (p=0.003) on VAS score as the Morphine group did experience less pain.
There was a small statistical difference on constipation as the Morphine group experienced less. 
Nausea and vomiting were the same.
One patient on Morphine developed acute renal failure and had to go on to dialysis for a week. She was switched back to Fentanyl TDS 
Conclusion: We believe that blind studies need to be done and confirm our results. In our open label study, the Morphine group did better and can be a good alternative on patients with refractory cancer pain in end stage

A COMPARISON STUDY OF TDS FENTANYL AND TDS MORPHINE ON LATE STAGE CANCER PATIENTS WITH REFRACTORY PAIN.