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Introduction
Transtec® matrix patches contain the strong opioid analgesic, buprenorphine in a transdermal delivery system. Clinically effective levels are reached after one day and the patches provide pain relief for the full 96-hour application period.
The following are real case studies of patients who have been successfully treated with Transtec® matrix patches. Most of these patients had previously received other analgesics, but had remained in pain. To the best of our knowledge, these patients were treated according to the licensed indications for Transtec® matrix patches, i.e. moderate to severe cancer pain and severe pain not responsive to non-opioid analgesics.
In a long-term clinical trial in which patients with chronic non-malignant pain were treated with Transtec® matrix patches (35 μg/h) for an average of 6.6 months, 94.3%1 of patients had satisfactory or better pain relief.
Osteoarthritis
Case 1
This 89-year-old female patient had osteoarthritis with chronic joint pain and stiffness. She had pain on movement and at rest, and her mobility was limited. She was treated with nefopam (30 mg once-daily) and co-prescribed metoclopramide (10 mg) to control nausea. However, her compliance was an issue at times. She was switched to Transtec® patches (35μg/h). Her pain was well controlled and her stiffness and mobility improved. The nausea also resolved and an antiemetic was not required. The patient was described as ‘happy’ and compliance was no longer a problem.
Case 2
This 77-year-old female patient had chronic, severe osteoarthritis, characterised by pain on movement. She was treated with tramadol (150 mg twice-daily) and diclofenac (100 mg twice-daily) for the pain, and was also taking temazepam to help her sleep. She was switched to Transtec® patches (35 μg/h), supplemented with tramadol for breakthrough pain, and her pain was reduced by 30 – 40%. Her sleeping also improved and she was able to stop taking the temazepam.
Fractures secondary to osteoporosis
Case 3
This 62-year-old female patient developed an osteoporotic crush fracture, together with fractures of the sacrum and two ribs. She also had a history of rheumatoid arthritis and was receiving low-dose methylprednisolone. She was given tramadol to treat the fracture pain, and received physiotherapy, but these had little effect. She was therefore switched to Transtec® patches (35 μg/h) for five months. During this time, she was mobile and had good pain control. Her articular pain also diminished to the extent that the corticosteroids could be withdrawn at the end of the five month treatment period.
Case 4
This 50-year-old female patient presented with a vertebral fracture secondary to osteoporosis. She was in severe pain and confined to bed. She was treated with pamidronate and analgesics, and received physiotherapy, but these were not effective. She was therefore switched to Transtec® patches (35 μg/h). Pain control was good and the patient became mobile again. She was treated for six months, at which point she was mobile and painfree.
Case 5
This 75-year-old female patient had osteoporosis, with chronic back pain, sleep disturbance, anxiety, restlessness, and chronic constipation. She had been treated with paracetamol/codeine (4 g/240 mg per day), but was switched to Transtec® patches (35 μg/h). Her pain was well controlled and her other symptoms, including constipation, also resolved. The patient was described as being much more settled and content.
Low back pain
Case 6
This 47-year-old male patient had chronic low back pain and was waiting for a referral to a pain clinic. The cause of his back pain was unknown, although he had been in a traffic accident. He was started on Co-proxamol tablets (paracetamol 325 mg/ dextropropoxyphene 32.5 mg), but was eventually switched to tramadol. However, his pain was not controlled and he was therefore switched to Transtec® patches (35 μg/h). After starting the patches, the patient was pain-free and able to wait for his appointment at the pain clinic without discomfort.
Other types of pain
Case 7
This 54-year-old female patient had psoriatic arthritis and fibromyalgia syndrome. She had severe pain in her wrists and lower back, and was being treated with tramadol (600 mg), ibuprofen (600 mg), paracetamol (1 - 2 g), and an NMDA receptor antagonist, flupirtine (200 mg). She was switched to Transtec® patches (35 μg/h), supplemented with sublingual buprenorphine tablets for breakthrough pain, and reported good to satisfactory pain relief. This patient was taking part in a clinical trial and at the end of the trial, she requested to continue treatment with Transtec® patches (35 μg/h). She was treated for 34 months with no increase in dose.
Case 8
This 51-year-old female patient had a history of surgery for carpal tunnel syndrome and had also been treated for thoracic outlet syndrome. She presented with severe cervicobrachialgia radiating to her little finger with numbness. Examination revealed degenerative changes to her spine. The patient was treated with tramadol, several NSAIDs, and physiotherapy, but with no relief. She was switched to Transtec® patches (35 μg/h), which produced excellent analgesia within five days. Treatment was continued for three months and when it was stopped, the patient was pain free.
Case 9
This 52-year-old male diabetic patient presented with a bi-lateral frozen shoulder (diabetes is known to exacerbate this condition). He was unable to move his shoulders at all because of the intensity of the pain. The patient had received manipulation under anaesthetic, followed by physiotherapy and treatment with Co-codamol (paracetamol 500 mg/codeine phosphate 30 mg;*) and dihydrocodeine, but was still in pain. He was switched to tramadol, which provided some relief, and then to Transtec® patches (35 μg/h). His pain relief improved significantly, but not completely, so he was titrated to the 52.5 μg/h patch. The patient was described as being pain-free, and was able to travel abroad, go swimming, and look for employment.
*formulation not stated in case report
References:
1. Böhme K. Buprenorphine in a transdermal therapeutic system - a new option. Clin Rheumatol 2002;Suppl 1:S13-6.