Opioids in non-cancer pain: Activity limitations in chronic low back pain patients receiving transdermal fentanyl system: an interpretive guide to health-related quality of life

Abstract

Chronic low back pain (CLBP) patients often have much difficulty conducting daily activities. While certain physical functions measures are determined objectively (eg, decreased range of movement; gait speed), limitations in daily activities are typically measured subjectively. These measures of functioning are critical to improved patient outcomes. The aim was to determine the impact of chronic low back pain and of treatment with transdermal fentanyl on daily activities, and offer an interpretation regarding functioning. Observational study conducted at 17 clinical centers in the U.S. Eligible patients had CLBP diagnosis for at least 3 months and were transitioned from short-acting opioids to transdermal fentanyl. Patients completed the Treatment Outcomes in Pain Survey (TOPS), which includes the SF-36 Health Survey, at baseline and follow up. To interpret the meaning of score changes with this instrument, the content of several items was examined, focusing on limitations in the physical and social areas. Activity limitation is widespread in the CLBP population. In this study, 52% of patients were limited in their ability to walk one block, climb one flight of stairs, and bath/dress themselves. After treatment with transdermal fentanyl, 41% of patients reported these limitations, a reduction of 22% (p=0.034). At baseline, 81% of patients reported that their pain substantially interfered with their ability to conduct normal work (inside or outside of the home); after transdermal fentanyl treatment, 62% of patients reported this finding, a reduction of 23% (p=0.0001). At baseline, 67% of patients reported that their health substantially interfered with social activities; after transdermal fentanyl treatment, 47% of patients reported this finding, a reduction of 30% (p=0.0003). In this preliminary analysis in a usual-care setting, transdermal fentanyl treatment for at least 9 weeks significantly improved activity limitation in CLBP patients. Improvement was especially noted in patients with more severe activity limitations.