Transdermal Creams Can Reduce Oral Pain Medication Use in Elderly Patients

LAS VEGAS—Nonsystemic transdermal (NST) therapy can significantly reduce pain, improve quality of life, and reduce and replace use of oral pain medications in patients 65 years and older with a variety of chronic pain conditions.

That's the conclusion of a presentation at PAINWeek 2014 that explored patient-reported outcomes of the effect of the use of customized nonopiate-based creams in reducing the use of specific classes of oral pain medications.

Dean Juge, PharmD, of the University of Alabama at Birmingham, and Chief Science Officer at DeTOURE, a patient-reported outcomes-focused research company specializing in chronic pain management, and colleagues used an institutional review board survey that incorporated the MD Anderson Brief Pain Inventory to capture pain severity levels and quality of life metrics at baseline, week 1, and week 4 from 925 elderly patients.

Specifically, they were asked to indicate whether their use of oral pain medication had decreased, increased, or stayed the same while undergoing NST pain therapy. If decreased, they were asked to indicate the drug class and specific drugs whose uses were decreased while on NST.

This group represented a subpopulation of 3587 patients prescribed nonopioid-based transdermal pain creams who agreed to participate in the study.

The data showed that NST pain creams reduced pain severity by 21%, improved physical and emotional qualify of life metrics by 23% and 25%, respectively, and reduced the use of oral pain medications in 38% of the population.

Of the 38% of patients, 55% reported reduction in use of antiinflammatory agents; 38% in use of opioids; 28%, nutritional supplements; 21%, anticonvulsants; 18%, antidepressants; and 17%, topical agents.

Among the 38% who reported a reduction in opioid use, 45% reduced hydrocodone use; 35%, tramadol; 18% oxycodone; 5%, codeine compounds; 5%, fentanyl; 5%, morphine; and 3%, hydromorphone.

Minor adverse events were reported in less than 5% of patients, and no severe adverse events were observed.

Dr. Juge pointed to the American Geriatric Society statement on the use of opioids in the treatment of persistent pain in older adults, which notes that persistent pain is undertreated in the elderly, leading to many adverse outcomes. In addition, because of alterations in drug absorption, distribution, metabolism, and excretion, resulting from age-related changes—including in CNS, hepatic, and renal functions—treating chronic pain in patients who are elderly with oral pain medications is a less attractive option.

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