• Rudolf Likar, Eva-Maria Vadlau, Christian Breschan, Ingo Kager, Maria Korak-Leiter, and Gerda Ziervogel.
• Zentrum für interdisziplinäre Schmerz und Palliativmedizin, des Landeskrankenhaus Kärnten, Klagenfurt, Austria. r.likar@aon.at
• Clin J Pain. 2008 Jul 1;24(6):536-43.

ObjectivesTo compare the efficacy and tolerability of transdermal buprenorphine in elderly patients and 2 younger populations, all requiring analgesic treatment for moderate-to-severe chronic pain.MethodsThree equally sized age-groups (A>/=65, n=30; B=51 to 64, n=27; CResultsDistribution of pain causing diagnoses was comparable between age-groups, predominantly musculoskeletal disorders (65% of all diagnoses), diseases of the nervous system (13%), injuries (8%), and cancer (5%). Mean buprenorphine patch doses were 35, 50, and 40 mug/h (groups A, B, and C) at end of study. Pain intensity significantly decreased from pretreatment [visual analog scale (VAS)=57% and numerical rating pain scale=5.9 points) until the end of the study (day 28: 34% and 3.8 points; n=55), without differences between age-groups (VAS day 28: A=34%; B=34%; C=33%). Two-third of patients (A=67%; B=67%; C=68%) completed the study at day 28; the rates and reasons for premature study termination were similar in all age-groups. Daily mean pain intensities (days 10 to 28) were even lower (P<0.005) in elderly patients (VAS A=35.8%) as compared with both younger age-groups (B=39.8%; C=39.9%). Sleep duration incidences above 6 hours improved from 34% to a plateau above 50% (A=68%; B=38%; C=57%) for patients terminating the study as planned. The need for rescue medication was lowest in elderly patients (A=107; B=136; C=253 mug/d, days 10 to 28). The opioid typical adverse event profile (predominantly dizziness and nausea) and local skin tolerability were both comparable for younger and elderly patients.ConclusionsThis investigation showed that the treatment of chronic pain with transdermal buprenorphine in elderly patients above the age of 65 years is at least as effective, tolerable, and safe as in patients studied in 2 age-groups below that age.

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