Efficacy of transdermal buprenorphine patch for chronic non-cancer pain

Main Category: Pain / Anesthetics
Article Date: 24 Aug 2005 - 12:00 PDT

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This small study set out to evaluate efficacy in the specific use of transdermal buprenorphine patches for the treatment of chronic non-oncological pain.

15 patients were involved in the study, 9 men and 6 women, all suffering with severe pain (visual analogue scale (VAS) cm 9.2) that was either neuropathic (13) or from spondylolisthesis (2). They had all previously been treated unsuccessfully with medications including: COX2 inhibitors, NSAIDs, anticonvulsants and both weak and strong opioids.

Dose was titrated upwards beginning with a preliminary treatment of methoclopramide 30 mg/die/os for one week. The buprenorphine transdermal patches (TDS) regimen was then started with a quarter of 37.5 mcg/h buprenorphine TDS patch, increasing by another quarter every 3 days until effective dose was achieved. Patients continued on the trial for a total of 24 weeks, returning for a check-up every week for the first four weeks and then every month until completion of the trial. Over the nine check-ups, investigators checked VAS pain scores, number of rescue doses used, any side effects and adjuvants used.

By the end of the first month, when buprenorphine had been titrated to at least one full patch, VAScm scores dropped from a mean of 9.5 to just 2, which was sustained until the end of the trial. Rescue doses of 0.2mg buprenorphine tablets started with a mean of 4.2 a week but completely stopped by the fourth week. Similarly, side-effects were minimal in the last five months of the trial and adjuvant use occurred just once a month after completion of titration.

These results demonstrate the efficacy of buprenorphine TDS patches, not only in terms of pain relief but also in its favourable side effect profile. Similarly the progressive titration is a useful example of effectively minimising complications and side-effects and undoubtedly contributed to the 100% patient compliance with the study protocol.

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