Demand for emergency department care for vertebral fractures treated with transdermal buprenorphine vs. other analgesics

Objective.

To compare the results of emergency department management of spinal pain from vertebral fractures (in terms of revisits, adverse effects at 90 days, or need for hospitalization because of poor pain control at 6 months) in patients treated with transdermal buprenorphine or another analgesic.

Methods.

Retrospective observational study of cohorts in an emergency department database compiled prospectively over a period of 18 months. We included all patients over the age of 60 with a radiologic diagnosis of vertebral fracture or compression causing pain for more than 3 months. Records were stratified according to the World Health Organization (WHO) analgesic scale, which was used when the patients were treated. Variables related to effectiveness were revisits at 1 month, time between visits in days, and the need for hospitalization.

Results.

A total of 180 patients were included; 39 were treated with drugs on the first step of the WHO’s analgesic ladder, 74 with second-step drugs (mainly tramadol), and 67 with transdermal buprenorphine, a third-step drug. Half the patients treated with buprenorphine had revisited at 50 days or later (interquartile range [IQR, 41–60 days); half those treated with first-step analgesics had revisited by 19 days IQR, 10–37 days), and half those on second-step drugs had revisited by 28 days (IQR, 21–53 days) (P<.001). After adjustment for other variables, patients treated with first-step drugs revisited 4.19-fold more (95% CI, 2.57–6.80; P<.001) and those treated with second-step drugs revisited 1.91-fold more (95% CI, 1.22–2.99; P=.005) more than patients treated with transdermal buprenorphine.

Conclusions.

Transdermal buprenorphine used to manage spinal pain seems to significantly reduce the need for revisits in comparison with treatments with first- or second-step analgesics.