Pharmaceutical treatment patterns for patients with a diagnosis related to chronic pain initiating a slow-release strong opioid treatment in Sweden

Abstract

Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The most common first prescription was oxycodone (54%) followed by fentanyl (19%), buprenorphine (14%), and morphine (13%). 63% refilled their prescription within 6 months, and 12% switched to another SRSO, most commonly fentanyl. After 3 years, 51% of cancer and 27% of noncancer patients still being in contact with health care remained on any SRSO. Of noncancer patients, 35% had a psychiatric co-medication (SSRI or benzodiazepine). In conclusion, fewer patients remain on SRSO in the long-term in clinical practice than reported in previous clinical trials. Oxycodone is the most common first SRSO prescription and one-third of patients get a prescription indicating psychiatric comorbidity. Our interpretation of these findings are that there is need for better treatment options for these patients, and that more effort is needed to improve treatment guidelines and to ascertain that these guidelines are followed.

Prescripción de opioides mayores en pacientes con dolor no oncológico: descripción de sus características en una zona de salud de atención primaria

“…(6) en población con edad a partir de 65 años, que era de 388 días. En un reciente estudio poblacional realizado en Noruega (21) se relata que el 24 % de los pacientes con opioides seguían con el tratamiento cinco años después de iniciado, y en uno similar llevado a cabo en Suecia (22), el 27 % seguían con el tratamiento a los tres años de iniciado. Aunque no podemos comparar nuestros datos con los de estos estudios debido a diferencias metodológicas, en nuestro caso el 4,2 % de los pacientes llevaban cinco años en tratamiento.…”

Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika

“…In einer schwedischen Studie wurden nach drei Jahren nur noch ca. ein Viertel der CNTS-Patienten, die eine Behandlung mit einem retardierten OA begonnen hatten, mit einem solchen Medikament weiterbehandelt, etwa ein Drittel bekam Antidepressiva oder BZD [56]. Einer älteren Übersichtsarbeit zufolge nahmen nach 7-24 Monaten (maximale followup Dauer) noch 44 % der chronischen Nicht-Tumor-Schmerz (CNTS)-Patienten ein OA [57].…”

New Drug Delivery Systems Concept in Anaesthesia and Intensive Care—Controlled Release of Active Compounds

“…Administered through TTS, Fentanyl acts in a minimally invasive manner, after a well-known kinetics, leading to increased patient satisfaction. The molecular weight of the active substance (337 Da), that does not overcome the maximal molecular weight adequate for skin permeability (1000 Da), as well as the fact that fentanyl is soluble in the lipid compartments of the skin (600 times more soluble than morphine), determines a continuous diffusion of the active compound in a safe, non-invasive manner that offers the patient increased comfort during the therapy [41,42]. There are different systems designed for the controlled release of fentanyl: TTS fentanyl-25 that releases 25 μg/h, TTS fentanyl-100 that releases 100 μg/h, and other doses.…”