Patient case (clinical description): A 47-year-old woman comes to the office complaining of pain in the calf and knee when she bends down. The pain limits her activity. Her medical history is significant for osteoarthritis, for which she uses nonsteroidal anti-inflammatory drugs (NSAIDs) for the past two years. She is living with her husband and has 3 children. She doesn't smoke but drinks alcohol occasionally. Her vital signs are normal. On physical examination, there is a small effusion in the right knee. The effusion grew a little larger and she developed a tender swelling in the popliteal fossa and calf. Both the pain and swelling worsened as she bent and straightened her knee.

Patient's own account: I'm a 47-year-old woman, married with 3 kids. I don't smoke and I drink occasionally. I went to the doctor because of pain in my calf and knee when I was bending down. This has been limiting my daily activities. I have been diagnosed with osteoarthritis for which I have taken anti-inflammatory drugs for the past 2 years. The doctor saw a small fluid buildup in my right knee. This buildup became a bit bigger and I have a swollen calf. The pain is worse when I bend and straighten my knee.

Clinical trial: Evaluation Of Efficacy And Safety Of Norspan In Moderate To Severe Pain Due To Osteoarthritis, Rheumatoid Arthritis, Joint/Muscle Pain

Eligibility criteria:
Inclusion Criteria:

          1. Males and females aged 18-80 years (both inclusive) at the time of recruitment.

          2. Clinical diagnosis of osteoarthritis, rheumatoid arthritis, lower back pain or joint /
             muscle pain.

          3. Having non-malignant pain of moderate or severe intensity requiring an opioid for
             adequate analgesia (according to local label of Norspan® or Sovenor®). This is to be
             determined using BS-11 scores, where the cut-off point is ≥4.

          4. Patients with chronic uncontrolled pain and is assessed to require opioid treatment
             but have not been treated with opioids (including tramadol, morphine etc.) within 4
             weeks or more before study entry.

        Exclusion Criteria:

          1. Pregnant and lactating females.

          2. Patients with chronic condition(s), in addition to osteoarthritis, that require(s)
             frequent analgesic treatment (e.g. frequent headaches, frequent migraine, and gout).

          3. Patients who are awaiting a scheduled operation or other surgical procedure during
             study period or 3 months or less post-operative.

          4. Prior history of being on opioids in the preceding 1 month prior to the study for the
             management of chronic non-malignant pain.

          5. Prior history of buprenorphine transdermal system use.

          6. Patients with history of allergic reactions against paracetamol/ acetaminophen, NSAIDs
             and/or opioids.

          7. Patients with allergies or other contraindications to transdermal systems or patch
             adhesives.

          8. Patients with dermatological disorders who may have problems applying patch or
             rotating patch placement area.

          9. Patients with cancer (except for basal cell carcinoma) or history of cancer who have
             been diagnosed within five years prior to the first study visit (except for treated
             basal cell carcinoma).

         10. Patients with conditions such as brain tumour, brain injury or raised intracranial
             pressure.

         11. Patients with history of psychiatric disorder, uncontrollable epilepsy, untreated
             depression or other psychiatric disorders of a type that would make participation in
             the study an unacceptable risk to the patient.

         12. Patients with any conditions causing poor cognitive function as assessed by the
             participating physician.

         13. Patients with history of alcohol and drug abuse or patients who have demonstrated
             behaviour that suggests a dependency or drug abuse.

         14. Patients currently taking hypnotics or other central nervous system depressants that
             may pose a risk of additional central nervous system depression with study medication.

         15. Patients who are currently being administered monoamine oxidase inhibitors (MAOIs) or
             have taken MAOIs within 2 weeks before screening.

         16. Patients requiring dose titration of adjuvant analgesics i.e. antidepressants (e.g.
             amitriptyline, amoxapine, clomipramine, selective serotonin re-uptake inhibitors
             (SSRIs)) and anticonvulsants (e.g. gabapentin, pregabalin). Patients will be allowed
             to enter the study as long as they are on the stable doses of adjuvant analgesics at
             screening and do not have dose adjustments during the study.

         17. Patients who have received steroid treatment (intra-articular, intramuscular, oral,
             intravenous, epidural or other corticosteroid injections) within 6 weeks prior to
             clinical study or planned steroid treatment during the clinical study period.

         18. Patients who have to use heating facility (examples: heating lamp, electric blanket,
             sauna, warm compresses, heated saline baths, etc.).

         19. Patients who cannot or do not wish to remove hair growing at body surface where the
             patch can be placed.

         20. Patients who are currently on disability claims or in the process of applying for
             disability claims.

         21. Patients at child-bearing age who are planning to conceive a child during the study
             period and are not practicing adequate contraception.

         22. Patients with known severe hepatic impairment as determined by liver function test
             within the past one year.

         23. Patients who are currently in or have participated in other clinical trials within the
             last 30 days prior to study recruitment.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Entailment