Burprenorphine穿皮貼片劑應用於脊椎手術後慢性疼痛之年長者

The Application of Burprenorphine via Transdermal Patch in Elderly with Chronic Pain after Back Surgery

丁丙諾啡（burprenorphine，sovenora）穿皮貼片已被批准可使用於治療慢性非癌症的疼痛治療，是一種半合成的鴉片類麻醉性止痛藥物，對老年人而言，各種器官的老化，骨質流失而造成骨折，甚或是認知功能衰退，都影響了醫師對其疼痛治療策略考量的方向。本案例研究，藉由台灣某醫學中心使用T丙諾啡穿皮貼片以治療老年人脊椎手術後所造成之嚴重慢性疼痛之成功參考，本案例研究，提供了兩位因「脊椎手術後疼痛症候群」而深受嚴重背部疼痛困擾的老年人。在使用丁丙諾啡穿皮貼片治療後，而有不錯成效的分享。在使用丁丙諾啡穿皮貼片治療之前，這兩位病人因慢性下背疼痛的困擾，而多種口服非類固醇類止痛藥或鴉片類止痛藥的治療。卻不見其療效，然而，在嘗試丁丙諾啡穿皮貼片後，能達到不錯的減痛效果。儘管這兩位病人同時配合其他非類固醇類口服止痛藥物或局部類固醇注射的合併治療，也沒有造成無法忍受之藥物副作用或交互作用。對於因「背部手術後疼痛症候群」而導致持續性中重度下背疼痛的老年人而言。丁丙諾啡穿皮貼片可以方便且有效的改善其疼痛的症狀。當疼痛科M師們在面對年長病人，主訴有嚴重，慢性之後背疼痛時，在過去病史、手術史、藥物效能、安全性、病人耐受性，及藥物成本花費的考量下，可以考慮嘗試使用丁丙諾啡穿皮貼片作為疼痛控制的選擇策略之一。

Abstract: Transdermal burprenorphine patch(sovenor®) is an opioid analgesic used in the management of moderate to severe pain via transdermal pathway. Chronic pain represents a significant challenge to the elderly and physician. Many elderly patients suffer from cognitive impairment, physiological decline in organ function, or osteoporosis, can lead to problems of compliance of taking medicine, describing pain, or side effects. The case series is to discuss the efficacy and safety of transdermal burprenorphine patch in elderly patients with chronic low back pain due to post back surgery syndrome. We presented two elderly patients demonstrating successful therapy of transdermal burprenorphine patch in management for chronic severe low back pain. The two patients once took other pain killers of oral non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics before the use of transdermal burprenorphine patch, but in vain. However, transdermal burprenorphine patch worked effectively in those patients’ symptoms, and the elderly tolerated transdermal burprenorphine patch well under good compliance. Also, multiple pain management of transdermal burprenorphine patch combined with oral NSAIDs, or local anesthetic injection, did not lead to side effects due to druginteractions. In conclusion, transdermal burprenorphine patch is an easy and effective way in treating elderly patients who suffer from moderate to severe pain due to post back surgery syndrome, and to be a safe analgesic for the elderly. In light of the evidences for efficacy, safety, tolerability, and cost, physicians may consider transdermal burprenorphine patch under the considerations of their past medical or operation history, as the priority choice as pain management in the elderly.