Background Previous studies demonstrated that lumbar and dorsal pain episodes are two to three times more frequent in patients of the same age when a documented vertebral fracture is present. Many treatments have been tested in musculoskeletal pain with different results. There are no studies conducted to compare different therapeutic strategies in back pain treatment related to non-acute vertebral fractures in terms of recidivism in an urgency enviroment.
Objectives To compare the effectivenes of buprenorphine transermal therapy with other level of OMS pain control therapies in terms of urgency recidivism.
Methods A retrospective observational study was conducted. Data was retrieved from the database of registries of A&E department of our hospital and the follow up registries of the rheumatologic and musculoskeletal urgencies unit. No identity data was gathered. Registries included had the following criteria: (1) Al least 60 years old, (2) Radiological demonstration of a previous known vertebral fracture/collapse since at least 3 months, and (3) chief complain related to dorsal or back pain. Patients were grouped according to the treatment at discharge: First scale of the WHO pain treatment ladder (Group I), second scale (Group II) and Transdermal buprenorphine (Group III). Main outcome variable was the time until the need of a further urgent assessment (Kaplan-Meier curve).
Results 180 registries were analyzed. Group I, II and III contained 39, 74 and 67 cases. No demographic statistically significant differences were founded between groups. Group I consisted by patients who underwent treatment with metamizol, paracetamol or both (24), NSAID alone or associated with metamizol or paracetamol (15). Group II consisted by patients who underwent treatment with an average dose of 155mg/day of tramadol (range 37.5–300mg/day) and patients treated with codein (2). Group III consisted by patients treated with 35 mcg/72h of transdermal buprenorphine, 50 mcg/72h (2) and 70 mcg/72h (1). 50% of patients of group III had to be assessed after the 50th day since the first urgent visit (ICR 41–60), while same proportion of patients from group I and II consulted at the 28th (ICR 21–53)and 19th (ICR 10–37) day, respectively. Patients from group I drugs increase their re-assessment rate 4.19 fold (CI95% 2.57–6.80; P<0.001) while patients from group II have a 1.91 fold re-assessment rate (CI95% 1.22–2.99, P=0.005) compared with group III patients. 3/39, 10/74 and 1/67 patient from groups I, II and III, respectively requested a new urgent assessment due to what was finally interpreted as a prescription side effect. Tramadol users (Group II) had a significantly higher proportion of side effects than transdermal buprenorphine by the first month (P=0.01). There were no statistically significant differences between proportions of side effects in patients from group I compared to group III (P=0.14)
Conclusions Treatment with transdermal buprenorphine in patients with non-acute vertebral fracture seems to reduce the ratio of further need of urgent re-assessments compared to tramadol or first scale drugs of the WHO-pain treatment ladder.
Disclosure of Interest None declared