Transdermal fentanyl for chronic low back pain.
OBJECTIVE
Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are sometimes non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the efficacy of transdermal fentanyl in the treatment of chronic low back pain.


METHODS
This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy.


RESULTS
Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 μg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effective in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%).


CONCLUSIONS
Transdermal fentanyl significantly improved visual analog scale scores and Oswestry Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. sohtori@faculty.chiba-u.jp
Seiji
S
Ohtori
Gen
G
Inoue
Sumihisa
S
Orita
Yawara
Y
Eguchi
Nobuyasu
N
Ochiai
Shunji
S
Kishida
Masashi
M
Takaso
Yasuchika
Y
Aoki
Kazuki
K
Kuniyoshi
Junichi
J
Nakamura
Tetsuhiro
T
Ishikawa
Gen
G
Arai
Masayuki
M
Miyagi
Hiroto
H
Kamoda
Miyako
M
Suzuki
Tomoaki
T
Toyone
Kazuhisa
K
Takahashi
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D005283:Fentanyl