Evaluación del tratamiento del dolor crónico en pacientes oncológicos con buprenorfina transdérmica

摘要

Introduction. The concern with chronic severe pain in cancer patients is growing as antineoplastic therapeutic advances are procuring prolonged survival in many patients. This necessitates the development of new effective and safe analgesic treatments. For this purpose, the comparison of therapeutic outcomes with that obtained in non-cancer patients may be helpful. Methods. A prospective, uncontrolled observational study that included a 3 month follow-up of patients starting transdermal buprenorphine was performed. Information was collected systematically on pain relief, quality of life (EuroQol-5D questionnaire), comfort of patch use and adverse events. Missing data were imputed by carrying forward former observations. This article refers to the comparative results of a subgroup of 207 cáncer patients with that of 968 non-cancer patients that participated in the same study. Results and conclusions. 30% of cáncer patients switched to transdermal buprenorphine from other opioid drug. Dose increases were required by 44% of patients, and most occurred in the first month; this proportion being significantly greater (p<0.001) than among non-cancer patients (18.8%). More than two third achieved satisfactory pain relief, regardless of the origin of pain. There was a significant increase of quality of life score that was, nevertheless, lower among cáncer patients (by an average of 12.2 mm in a visual analogue scale) than among non-cancer patients (17.1 mm); that was mainly attributed to pain improvement. The proportion of patients with adverse events was significantly lower among cáncer (42.0%) than non-cancer patients (49.1%), p=0.010. This was true also for related adverse events and withdrawals because of adverse events. Conversely, more cáncer patients had serious adverse events or died during follow-up; although in none case these were related to buprenorphine treatment. Conclusions. Within the opioid class, the transdermal formulation of buprenorphine is effective and safe for the treatment of modérate to severe chronic pain in non-terminal cáncer patients.