Retrospective Analysis of 4 Years of Clinical Experience with Transdermal Buprenorphine (Transtec^®) in Post-Traumatic Pain

SUMMARY: 

Aims: To evaluate the effectiveness and safety of transdermal buprenorphine (BTDS) in the treatment of post-traumatic pain in a working population. Patients & methods: Retrospective case series of patients with severe post-traumatic pain treated with BTDS between 2008 and 2012. Results: 57 patients were evaluated: 38 men, 19 women (mean age 43 years); patients with burns (n = 22), skin degloving (14), open dislocations (eight), traumatic nerve lesions (six), spinal cord injury (four) and limb amputations (three). 25, 12 and 20 patients experienced neuropathic pain, nociceptive pain or neuropathic/nociceptive pain, respectively. The mean baseline DN4 questionnaire and pain intensity scores were 4.8±2.3 and 7.4±1.5, respectively. The mean duration of pain before BTDS use was 24.4 months (>3 months in 65% of patients). Total patient-years of BTDS treatment were 73. After 14.7±14.9 months of BTDS treatment, mean pain intensity was reduced by 4.2±2.2 points, 38 patients (66.7%) had ≥50% pain relief, 69% reported functional improvement, especially in gait ability (25) and activities of daily life (14), and 46 patients (80.7%) had improved sleep quality. The starting dose of BTDS was 4.4–17.5 μg/h; maintenance dose was 8.8–70 μg/h. At the start of BTDS treatment, all patients used a total of 187 concomitant analgesics daily, 72% of which were stopped during treatment with BTDS; the number of patients that could be managed exclusively with BTDS and rescue analgesia increased to 31%. 13 patients (22%) presented nausea, eight constipation, six local skin reactions, three vomiting and somnolence, and two patients experienced dizziness. Four patients (6.9%) stopped BTDS due to adverse reactions. Conclusions: BTDS is an effective and safe alternative for the treatment of patients with severe post-traumatic pain, reducing the intensity of pain and improving functional capacity and quality of sleep.

KEYWORDS:

• post-traumatic pain
• severe pain
• transdermal buprenorphine

Acknowledgements

The authors thank senior staff and colleagues from the Rehabilitation Department of the Hospital del Trabajador de Asociación Chilena de Seguridad for their support in conducting this study. In particular, we thank C Gastó who helped us in the stages of bibliographical research and revision of the study.

Financial & competing interests disclosure

G Correa-Illanes has had a previous consultancy relationship with Grünenthal GmbH. R Roa, JL Piñeros, FT Ferrer and VR Adriasola have no financial or other relationships to declare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors also thank DP Figgitt, Content Ed Net, for providing editorial assistance, funding for which was provided by Grünenthal GmbH.

Ethical conduct of research

The authors state that they have obtained appropriate insti­tutional review board approval or have followed the princi­ples outlined in the Declaration of Helsinki for all human or animal experimental investigations.