Network Meta-analysis of Safety and Efficacy of Analgesic Transdermal Patches Based on VAS or NRS Pain Scales Across Various Pain Conditions in Non-cancer Patients
Rohit Hemnani, Shikha Sood, Nishant Prajapati, Supriya MalhotraBackground:
Transdermal analgesic systems utilise a prolonged-release mechanism that enhances patient adherence, making them a frequent choice for managing diverse acute and chronic pain states. Nonetheless, robust head-to-head data evaluating their comparative therapeutic value and tolerability profiles specifically for non-malignant pain conditions remain scarce.
Aims:
The aim of this investigation was to assess and contrast how distinct transdermal pain relief patches perform regarding therapeutic success and safety margins among cohorts experiencing non-cancerous chronic pain.
Methods:
To evaluate and rank the therapeutic success and safety profiles of transdermal analgesics, we executed a comprehensive literature search across Scopus, Embase, PubMed Central and PubMed for randomised controlled trials (RCTs) published between 2010 and 2023. Ultimately, 22 RCTs comprising an aggregate pool of 3,787 non-malignant individuals met our criteria. The primary therapeutic metric was defined as pain mitigation, quantified via Numeric Rating Scale (NRS) or visual analogue scale (VAS) records, while safety tracking rested on overall side effect frequencies. Both direct evidence lines and indirect modelling loops were implemented to determine final drug hierarchies.
Results:
Data from 22 RCTs demonstrated that all evaluated transdermal patches were effective in reducing pain in non-cancer patients. Based on direct comparisons using the VAS scale, buprenorphine showed the greatest efficacy (SMD = 1.161, 95% CI,
Conclusion:
This meta-analysis demonstrates that transdermal analgesic patches are effective and generally well tolerated for the management of non-cancer pain. Among the evaluated interventions, buprenorphine exhibited the highest efficacy in studies using the VAS scale, whereas diclofenac showed superior efficacy in studies employing the NRS scale. Safety analyses similarly favoured buprenorphine in VAS-based studies and diclofenac in NRS-based studies. Although all evaluated patches provided meaningful pain relief, differences in efficacy and safety rankings suggest that patch selection should be individualised according to patient characteristics and clinical requirements. These findings provide comparative evidence to support informed decision-making in the management of non-malignant pain.