For Chronic Pain Patients Unrelieved by High-Dose Opioids, What Next?

the MPR take:

For chronic pain patients being unsuccessfully treated with high-dose full-opioid agonists, switching to sublingual buprenorphine, may provide effective pain management and improve a patient’s quality of life.  Prolonged opioid therapy can result in tolerance, dependence, and opioid-induced hyperalgesia; it has also been linked to decreased fertility and libido and immunosuppression. While progressively higher doses of opioids may help treat pain initially, repeated dose escalations could lead to more adverse effects.  Buprenorphine is a partial agonist at the mu-receptor and an antagonist at the kappa-opioid receptor; based on the literature, it has been shown to have a high safety profile and a low level of physical dependence. In a study published in the journal Pain Medicine, 35 chronic pain patients were converted from high-dose opioid therapy (preconversion daily morphine equivalents ranged from 200mg to 1370mg) to buprenorphine SL.  After two months of therapy with buprenorphine SL, average pain scores dropped from 7.2 to 3.5; quality of life scores increased from 6.1 to 7.1. Based on this data, researchers conclude that buprenorphine SL should be considered for chronic pain patients unrelieved by their current opioid regimens. For clinicians who are uncomfortable with prescribing high-dose opioids, buprenorphine SL may be considered an effective alternative.

This study aims to determine the effectiveness of converting patients from high doses of full-opioid agonists to sublingual (SL) buprenorphine.