Retrospective analysis of 4 years of clinical experience with transdermal buprenorphine (Transtec) in post-traumatic pain.
OBJECTIVE
To evaluate the effectiveness and safety of transdermal buprenorphine (BTDS) in the treatment of post-traumatic pain in a working population.


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.
Department of Rehabilitation, Hospital del Trabajador de Asociación Chilena de Seguridad, Santiago, Chile.
Gerardo
G
Correa-Illanes
Ricardo G
RG
Roa
José Luis
JL
B Piñeros
Flavia T
FT
Ferrer
Victoria R
VR
Adriasola
D000062:Accidents, Occupational; D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010349:Patient Compliance; D012189:Retrospective Studies; D062707:Return to Work; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
D000701:Analgesics, Opioid; D002047:Buprenorphine
post-traumatic pain; severe pain; transdermal buprenorphine