A Novel Application of Buprenorphine Transdermal Patch to Relieve Pain in the Knee Joint of Knee Osteoarthritis Patients: A Retrospective Case-Control Study.

Ho Young Gil,Bumhee Park,Sooil Choi,Jae Hyung Kim,Yi Hwa Choi,Jae Chul Koh,Jong Bum Choi,Na Eun Kim,Hae Won Jeong,Sook Young Lee,Hyun Joong Kim,Sungchul Park,Bora Kim,Hye Seon Lee,Sang Kee Min,Ji Hyun Park,Byung Ho Lee

doi:10.3390/jcm8071009

Abstract

Osteoarthritis (OA) is considered to be one of the most disabling diseases. The intra-articular opioid injection has been widely studied for its simplicity, safety, and efficacy in OA. In this study, however, we suggest a novel method of buprenorphine transdermal patch (BTDP) to painful knee joints of OA patients, instead of intra-articular opioid injection, and subsequently compared the knee application with conventional chest application. We retrospectively enrolled 213 patients with knee OA who did not respond to conventional therapy. The Numeric Rating Scale (NRS), adverse effects, and compliance were recorded before and after the application of the BTDP. All parameters were compared between the knee applied group and the chest applied group. After the BTDP application, the NRS score in the knee applied group was lower than that of the chest applied group (p = 0.007). NRS scores after buprenorphine patch decreased to 2.21 ± 0.77, and 2.55 ± 0.71 in the chest applied group and the knee applied group, respectively. The adverse effects were 19.32% in the knee applied group, and 64.00% in the chest applied group. The compliances were 82.95% and 37.60% in the knee applied group and chest applied group, respectively. This novel application of BTDP directly to the painful knee joint of knee OA patients led to a decrease in the NRS score, adverse effects, and an increase in compliance compared with the chest application method.

Highlights

Osteoarthritis (OA) is considered to be one of the most disabling diseases in developed countries [1], with pain being its most significant symptom, and it is often difficult to manage due to aggravation by weight-bearing and movement of the hip and knee joints
The purpose of this research is to study the analgesic effects, adverse effects, and compliance of the buprenorphine transdermal patch applied to painful knee joints of knee OA patients, and to compare the knee applied group with the conventional chest applied group with respect to all parameters (Figure 2)
In per protocol analysis, there were no differences between the chest applied group and the knee applied group (Table 3)

Summary

Introduction

Osteoarthritis (OA) is considered to be one of the most disabling diseases in developed countries [1], with pain being its most significant symptom, and it is often difficult to manage due to aggravation by weight-bearing and movement of the hip and knee joints. Medication including paracetamol, traditional nonsteroidal anti-inflammatory drugs (NSAIDs), and selective cyclooxygenase-2 inhibitors may be administered to relieve pain that originates from the joints; NSAIDs and selective cyclooxygenase-2 inhibitors show many potentially serious side effects, especially in elderly patients [2]. When injected at the end of arthroscopic surgery, the IA opioid could reduce postoperative pain through peripheral opioid receptors [7]. Another opinion suggested that inflammation would destroy the perineurium of the nerve, and opioids would be better transported to opioid receptors due to the destroyed perineurium. It has been reported to reduce pain through these pathways [8], such as inflammatory reaction [9,10,11]

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Conclusion