Background & Aims
Buprenorphine in transdermal form has been used in the treatment of chronic moderate to severe pain of both cancer and non-cancer origin for more than 20 years. It is now available in our country in a new 7-day extended-release form. This atypical opioid is a partial agonist of the opioid µ receptors and an antagonist of the ? and ? receptors, resulting in a favourable analgesic profile for the whole spectrum of patients. It is now available in dosages of 5, 20, 30 and 40 µg/hr, differing from other transdermal buprenorphine in that it is released over a 7-day period.
Methods
We used a slow-release transdermal formulation in patients with chronic musculoskeletal pain with gradual dose titration over 1 month.
Results
From April to June 2023, we deployed slow-release transdermal buprenorphine in 108 patients, 76 women, 32 men, age range 28-87 years, mean age 63.9 years. The indications for therapy were chronic back pain in 56% of patients, osteoarthritis in 8% of patients, and chronic back pain with osteoarthritis in 36% of patients. The baseline dose was 5 µg/hr in 40% of patients, 10 µg/hr in 10%, 20 µg/hr in 43%, 30 µg/hr in 6%, and 40 µg/hr in 1 patient (1%). A total of 61% of patients reported no adverse reactions, 20% of patients had 1 adverse reaction, 11% of patients reported 2 adverse reactions, and 3 or 4 adverse reactions were reported by 1 patient. The most commonly reported adverse reactions were drowsiness and malaise (11%), followed by indigestion (10%), dizziness and lightheadedness, and local reactions (9%) and pruritus in 5%. Other adverse effects (convulsions, palpitations, headache) were less common.
Conclusions
This new form of transdermal buprenorphine is well tolerated, even in patients who reported intolerance to tramadol or other opioids. The overall incidence of adverse events has been low, although the follow-up period for patients is still relatively short. On the other hand, however, the incidence of local reactions may be overestimated by the hot summer currently underway. In opioid-naive patients, we usually found a starting dose of 5 µg/hr sufficient, especially in elderly patients; in patients converted from tramadol or other opioid analgesics, we opted for a starting dose of 10 µg/hr or 20 µg/hr. If even a dose of 40 µg/hr was insufficient at titration (in 2 patients), we switched to rapid-release buprenorphine at 52.5 µg/hr.
Slow-release transdermal buprenorphine is a suitable and gentle analgesic for chronic non-cancer musculoskeletal pain even in elderly patients according to our first experience.
References
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Presenting Author
Jan Procházka
Poster Authors
Jan Prochazka
MD, PhD
Masaryk Hospital
Lead Author
Topics
- Treatment/Management: Pharmacology: Opioid