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• W2465211208 abstract "Background: Opioid use in chronic pain management is controversial. We continue to see patients on inappropriate doses of opioids above the British Pain Society suggested maximum of 180 milligrams morphine equivalent per day. 1 The aim of this study was to evaluate the long-term effectiveness of buprenorphine patches, in terms of improvement in function or pain relief in a select group of short term responders, 4 years after starting treatment. Methods: Patients with chronic non-malignant pain attending the pain clinic at Sheffield Teaching Hospitals (STH) from May 2009 to June 2011 and deemed suitable for strong opioid treatment were initiated on buprenorphine patches. A prospective clinical evaluation study was undertaken looking for improvement in pain and function at baseline, 1 month and 3 months. Patients who had responded with any degree of improvement in pain or function were considered to be responders. A long-term effectiveness follow-up study was then done with these responders 4 years from the start of their buprenorphine treatment. Data on improvement in pain and activity, the dose of buprenorphine patch, adverse effects and Patients Global Impression of Change (PGIC) was obtained. For the purpose of this study, a dose of less than 20 micrograms/ hour was considered to be a low-dose. 62 patients were started on buprenorphine patches as per the original study. We analysed data both in terms of patients originally included in the study (i.e. intention to treat, n=62), as well as patients with complete dataset throughout the initial 3 month study period (n=47). At the end of 3 months: With intention to treat, 23 patients (37%) out of 62 had improvement in pain or function. If analysed only in patients with complete dataset, 23 patients out of 47 (49%) showed good response. At the end of 4 years, we attempted to collect data from these 23 previous short term responders. Out of these 23 patients we were not able to contact 3 patients and one patient was deceased. Hence we have data for 19 patients. At the end of 4 years: On an intention to treat basis, 10 patients (16%) out of the original cohort of 62 showed improvement in pain or function. On a predetermined responder basis, 10 (52%) out of 19 patients who could be contacted were found to be benefitting with buprenorphine patches. PGIC data in these 19 patients showed that 4 patients were much improved while 6 patients were minimally improved. After 4 years, 8 patients out of 19 i.e. 42% were using a low dose of less than or equal to 20 micrograms/hour. Over these 4 years, 21 patients (33%) had to stop buprenorphine patch due to its side-effects. Conclusion: Our study shows that after 4 years, only 16 % of patients who were originally initiated on buprenorphine patches showed any improvement in pain or function. However, out of those patients who showed good short term response at the end of 3 months , around 52% continue to benefit from buprenorphine patches and that 42% of these short-term responders continue using low doses (i.e. less than or equal to 20 micrograms/hour). The most common reason for stopping treatment was its side-effects. It shows that buprenorphine could be effective on a long-term basis in a small subset of patients." @default.
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• W2465211208 date "2014-07-12" @default.
• W2465211208 modified "2023-09-28" @default.
• W2465211208 title "Does low dose opioid therapy remain effective long- term in chronic pain patients? A retrospective analysis of short-term responders to transdermal buprenorphine" @default.
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