To compare the efficacy and tolerability of transdermal buprenorphine in elderly patients and 2 younger populations, all requiring analgesic treatment for moderate-to-severe chronic pain.
Three equally sized age-groups (A≥65, n=30; B=51 to 64, n=27; C≤50 y, n=25) were examined during 28-day treatment periods to detect potential differences in responsiveness (pain intensity, rescue medication, sleep duration) to the transdermal opioid.
Distribution of pain causing diagnoses was comparable between age-groups, predominantly musculoskeletal disorders (65% of all diagnoses), diseases of the nervous system (13%), injuries (8%), and cancer (5%). Mean buprenorphine patch doses were 35, 50, and 40 μg/h (groups A, B, and C) at end of study. Pain intensity significantly decreased from pretreatment [visual analog scale (VAS)=57% and numerical rating pain scale=5.9 points) until the end of the study (day 28: 34% and 3.8 points; n=55), without differences between age-groups (VAS day 28: A=34%; B=34%; C=33%). Two-third of patients (A=67%; B=67%; C=68%) completed the study at day 28; the rates and reasons for premature study termination were similar in all age-groups. Daily mean pain intensities (days 10 to 28) were even lower (P<0.005) in elderly patients (VAS A=35.8%) as compared with both younger age-groups (B=39.8%; C=39.9%). Sleep duration incidences above 6 hours improved from 34% to a plateau above 50% (A=68%; B=38%; C=57%) for patients terminating the study as planned. The need for rescue medication was lowest in elderly patients (A=107; B=136; C=253 μg/d, days 10 to 28). The opioid typical adverse event profile (predominantly dizziness and nausea) and local skin tolerability were both comparable for younger and elderly patients.
This investigation showed that the treatment of chronic pain with transdermal buprenorphine in elderly patients above the age of 65 years is at least as effective, tolerable, and safe as in patients studied in 2 age-groups below that age.
Zentrum für interdisziplinäre Schmerz und Palliativmedizin, des Landeskrankenhaus Kärnten, Klagenfurt, Austria
Supported by a grant of Grünenthal GmbH, Aachen, Germany. The evaluation of the study was performed by CobraMed AG, Institut für Klinische Arzneimittelstudien, Kerpen, Germany, who also supported the preparation of the manuscript.
Reprints: Dr Rudolf Likar, MD, Leiter des Zentrums für interdisziplinäre, Schmerz und Palliativmedizin, Landeskrankenhaus Kärnten, Klagenfurt, St Veiter Str. 47, Klagenfurt A-9026, Austria (e-mail: firstname.lastname@example.org).
Received for publication March 17, 2006; revised December 17, 2007; accepted January 3, 2008
The authors declare that the experiments are compliant with the current laws of the country in which the experiments were performed.