Yonsei Med J.  2012 Jul;53(4):788-793. 10.3349/ymj.2012.53.4.788.

Transdermal Fentanyl for Chronic Low Back Pain

• Ohtori S
• Inoue G
• Orita S
• Eguchi Y
• Ochiai N
• Kishida S
• Takaso M
• Aoki Y
• Kuniyoshi
• Nakamura J
• Ishikawa T
• Arai G
• Miyagi M
• Kamoda H
• Suzuki M
• Toyone T
• Takahashi

• KMID: 1716879
• DOI: http://doi.org/10.3349/ymj.2012.53.4.788

Abstract

PURPOSE
Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are sometimes non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the efficacy of transdermal fentanyl in the treatment of chronic low back pain.
MATERIALS AND METHODS
This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy.
RESULTS
Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 microg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effective in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%).
CONCLUSION
Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.

Keyword

Transdermal fentanyl; low back pain; efficacy; adverse events

MeSH Terms

Administration, Cutaneous
Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Fentanyl/*administration & dosage/*therapeutic use
Humans
Low Back Pain/*drug therapy
Male
Middle Aged
Young Adult

Figure

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  Fig. 1 VAS scores in responders and non-responders. Month 0=before treatment. VAS scores after treatment were significantly lower than those before treatment in the responder group at each time point (p<0.01). However, pain scores one month after treatment and at final follow-up did not differ significantly from those before treatment in the non-responder group (p>0.05). VAS, visual analogue scale.

• 

  Fig. 2 VAS scores in responders and non-responders. Month 0=before treatment. VAS scores after treatment in the two responder groups were significantly lower than those in the non-responder group at each time point (p<0.05). VAS scores after treatment indicated that transdermal fentanyl was more effective in the responders awaiting surgery compared with the other responders at each time point (p<0.05). VAS, visual analogue scale.

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