The Use of Transdermal Buprenorphine in Complex Regional Pain Syndrome: A Report of Two Cases

Abstract

Management of complex regional pain syndrome (CRPS) can be challenging. Various pharmacological approaches have produced mixed results. Buprenorphine activates mu-opioid receptors and antagonizes kappa and delta receptors, acts at N-methyl-d-aspartate (NMDA) receptor, and is an orphan-related ligand-1 receptor agonist. It is available in transdermal patches that last for up to 7 days. This report describes two patients with refractory CRPS who were treated with transdermal buprenorphine. The patients experienced approximately 50% reduction in pain intensity scores. Application site rash that occurred was managed with topical steroid spray used before applying the patch.

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

“…There is little guidance on managing common adverse effects of TDB treatment in the manufacturer's prescribing information. Based on published recommendations and reports of clinical observations, 2,5,76,77 it is recommended that laxatives, antiemetics, and topical steroids be made available during the course of TDB treatment. As TDB is associated with a lower incidence of constipation than morphine, consider using a lower dose of laxatives.…”

“…5,75 As these symptoms are typically transient, antiemetics can generally be withdrawn within a few days of starting TDB treatment. 75 Physicians may consider applying topical steroids a few hours before applying the patch or immediately after removing the patch as per published clinical experience with TDB, 76,77 to minimize application site skin reactions.…”