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Rate ePoster

Pain and Spine Medicine

A New Patch Forward: A Case Report on Treatment of Chronic Pain in a 57-year-old woman with Progressive Scleroderma

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Ifeolu Akinnola, MD,PhD

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • TH

    Tiffany Holland, MD (she/her/hers)

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

  • KE

    Kaitlyn Egan, MD

    Assistant Professor, Attending Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

Disclosure(s):
Ifeolu Akinnola, MD,PhD: No financial relationships to disclose
Case Diagnosis: Middle-aged woman with chronic pain secondary to systemic sclerosis

Case Description or Program Description: Patient with scleroderma was referred to physiatry for management of chronic pain worsened by calcinosis. She also endured dysphagia, opioid induced constipation, insomnia, and interstitial lung disease. Since initial evaluation, her disease progressed requiring numerous hospitalizations for pneumonia and cachexia. Despite multiple medication adjustments, her pain became uncontrolled. The decreased benefit from her oral opioids was determined to be secondary to deceased absorption as her gastrointestinal system was affected by scleroderma. Our patient was transitioned to buprenorphine transdermal patch, replacing long-acting oral opioids, and resulted in better pain control.

Setting: Outpatient Rehabilitation

Assessment/Results: With worsening dysphagia, our patient had significant weight loss and eventually started on gastric tube feeds supplemented with total parenteral nutrition. It was determined that she likely had poor digestion and absorption of her opioids and other oral medications. Initiation of the transdermal buprenorphine proved beneficial as it circumvented the gastrointestinal (GI) tract absorption of oral medications with decreased opioid side effects and improved pain control.

Discussion (relevance): Systemic sclerosis is a progressive disease affecting multiple organ systems, notably musculoskeletal, integumentary, pulmonary, renal, and GI. Chronic pain is common and management can be difficult due to worsening pain and medication side effects. Due to worsening GI function in those with scleroderma, decreased metabolism of oral opioids can occur. Transdermal buprenorphine is an advantageous replacement for oral opioids in such cases as patients can regain pain relief and benefit from decrease in abuse potential, fewer side effects, and ease of use.

Conclusions: This case emphasizes the complexity of managing pain in a patient with a disease that affects multiple organ systems and the benefits of utilizing alternative routes of administration for pain management to increase function and quality of life.