title: Transdermal buprenorphine for the treatment of chronic noncancer pain in the oldest old.
abstract: BACKGROUND
  Chronic pain increases with age, and in the elderly, comorbidities and polypharmacotherapy make the choice of treatment for pharmacological pain control a complex matter.
  
  
  OBJECTIVE
  We conducted a multicenter, prospective, observational study to evaluate the efficacy and safety of the buprenorphine transdermal delivery system (TDS) in elderly patients with chronic noncancer pain. The aim was to assess the cognitive and behavioral status of patients during treatment.
  
  
  METHODS
  The study included 93 patients (69 women and 24 men); the mean age was 79.7 years, and in most cases, the pain was due to osteoarthritis. Almost three-quarters (74.2%) of the patients had suffered pain for more than 12 months. The treatment was buprenorphine TDS, starting from a dose of 17.5 μg/h. Outcomes were assessed using the Mini-Mental State Examination (MMSE), the 17-item Hamilton Depression scale (HAM-D 17), the Neuropsychiatric Inventory, the Barthel Index, the Short-Form Health Survey (SF-12), a verbal numeric rating scale, and the Cumulative Illness Rating Scale (CIRS).
  
  
  RESULTS
  Buprenorphine treatment was associated with a decrease in pain severity without negative effects on the central nervous system. On the HAM-D scale, there were reductions in both the psychological and somatic scores. On the MMSE, values at the beginning and end of the study were comparable. Evaluation by SF-12 showed improvements in physical and mental status. CIRS values at baseline and at the end of the study were superimposable, indirectly confirming the tolerability and safety profile of the drug.
  
  
  CONCLUSIONS
  Our experience confirms the analgesic activity and safety of buprenorphine TDS in the elderly. There was an improvement in mood and a partial resumption of activities, with no influence on cognitive and behavioral ability.
authors.affiliation: Geriatrics Unit, Istituto Nazionale di Ricovero e Cura per Anziani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. walgianni@hotmail.it
authors.forename: Walter
authors.initials: W
authors.lastname: Gianni
authors.forename: Angelo Raffaele
authors.initials: AR
authors.lastname: Madaio
authors.forename: Moira
authors.initials: M
authors.lastname: Ceci
authors.forename: Elena
authors.initials: E
authors.lastname: Benincasa
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Conati
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Franchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Nieddu
authors.forename: Bernardo
authors.initials: B
authors.lastname: Salani
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Zuccaro
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D001519:Behavior; D002047:Buprenorphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D002908:Chronic Disease; D003071:Cognition; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010003:Osteoarthritis / Q000150:complications; D010146:Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine