Geriatrics Unit, Istituto Nazionale di Ricovero e Cura per Anziani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
J Pain Symptom Manage. 2011 Apr;41(4):707-14. doi: 10.1016/j.jpainsymman.2010.06.015. Epub 2010 Dec 10.
Chronic pain increases with age, and in the elderly, comorbidities and polypharmacotherapy make the choice of treatment for pharmacological pain control a complex matter.
We conducted a multicenter, prospective, observational study to evaluate the efficacy and safety of the buprenorphine transdermal delivery system (TDS) in elderly patients with chronic noncancer pain. The aim was to assess the cognitive and behavioral status of patients during treatment.
The study included 93 patients (69 women and 24 men); the mean age was 79.7 years, and in most cases, the pain was due to osteoarthritis. Almost three-quarters (74.2%) of the patients had suffered pain for more than 12 months. The treatment was buprenorphine TDS, starting from a dose of 17.5 μg/h. Outcomes were assessed using the Mini-Mental State Examination (MMSE), the 17-item Hamilton Depression scale (HAM-D 17), the Neuropsychiatric Inventory, the Barthel Index, the Short-Form Health Survey (SF-12), a verbal numeric rating scale, and the Cumulative Illness Rating Scale (CIRS).
Buprenorphine treatment was associated with a decrease in pain severity without negative effects on the central nervous system. On the HAM-D scale, there were reductions in both the psychological and somatic scores. On the MMSE, values at the beginning and end of the study were comparable. Evaluation by SF-12 showed improvements in physical and mental status. CIRS values at baseline and at the end of the study were superimposable, indirectly confirming the tolerability and safety profile of the drug.
Our experience confirms the analgesic activity and safety of buprenorphine TDS in the elderly. There was an improvement in mood and a partial resumption of activities, with no influence on cognitive and behavioral ability.
慢性疼痛随着年龄的增长而增加，在老年人中，合并症和多药物治疗使得选择药物治疗来控制疼痛变得非常复杂。
我们进行了一项多中心、前瞻性、观察性研究，以评估丁丙诺啡透皮贴剂（TDS）在患有慢性非癌痛的老年患者中的疗效和安全性。目的是评估患者在治疗过程中的认知和行为状态。
该研究纳入了 93 名患者（69 名女性和 24 名男性）；平均年龄为 79.7 岁，大多数患者的疼痛是由骨关节炎引起的。近四分之三（74.2%）的患者疼痛持续时间超过 12 个月。治疗药物为丁丙诺啡 TDS，起始剂量为 17.5μg/h。使用简易精神状态检查（MMSE）、汉密尔顿抑郁量表 17 项（HAM-D 17）、神经精神问卷、巴氏指数、健康调查简表 12 项（SF-12）、言语数字评分量表和累积疾病评分量表（CIRS）评估疗效。
丁丙诺啡治疗与疼痛严重程度的降低相关，而不影响中枢神经系统。在 HAM-D 量表上，心理和躯体评分均有所下降。在 MMSE 上，研究开始和结束时的分值相当。SF-12 评估显示身体和精神状态均有改善。基线和研究结束时的 CIRS 值重叠，间接证实了药物的耐受性和安全性。
我们的经验证实了丁丙诺啡 TDS 在老年人中的镇痛活性和安全性。情绪得到改善，活动能力部分恢复，而认知和行为能力不受影响。
