A comparative study of intramuscular buprenorphine and morphine in the treatment of chronic pain of malignant origin.

Abstract

1 Twenty-seven patients with moderate to severe chronic pain of malignant origin received buprenorphine (0.3 mg) and morphine (10 mg) intramuscularly in a double-blind, single dose within patient study. 2 Efficacy analysis demonstrated no significant differences in the peak analgesic effects or in the time to reach these effects. However, buprenorphine had a significantly longer duration of action than morphine. 3 Sedation was the most frequent unwanted effect with a similar incidence following each treatment. Buprenorphine was associated with a significantly higher incidence, greater severity, earlier onset, and longer duration of dizziness, nausea and vomiting than morphine. 4 Following both treatments there were small but significant decreases in pulse rate, blood pressure, and respiratory rate.

The effectiveness of buprenorphine for treating cancer pain: an abridged Cochrane review

“…Overall, the data from only 91.8% of the total number of enrolled/randomised patients were analysed for pain and 85.6% for adverse events, which indicates that attrition bias was a substantial problem in this data set. Patients appeared to be adequately titrated in only four studies,25 27–29 and inadequately or not titrated in a further seven studies 14 21 24 33 35–37. Titration schedule or adequacy, or both, was unclear in the remaining eight studies.…”

“…The studies reported the following comparisons: Sublingual (SL) buprenorphine versus subdermal buprenorphine injection;35Sublingual buprenorphine versus oral tilidin+naloxone;30Sublingual buprenorphine versus oral tramadol;31 32Sublingual buprenorphine versus sublingual buprenorphine + oral phenytoin versus oral phenytoin;26Sublingual buprenorphine versus oral pentazocine;33Buprenorphine tablets/fluid versus pentazocine tablets/fluid;34Transdermal buprenorphine versus placebo;25 27–29Transdermal buprenorphine versus controlled-release morphine;14Transdermal buprenorphine versus transdermal fentanyl;38Intramuscular buprenorphine injection versus buprenorphine suppository;23Intramuscular buprenorphine versus intramuscular morphine;21 24Intramuscular buprenorphine+subcutaneous buprenorphine versus subcutaneous buprenorphine versus placebo+subcutaneous buprenorphine;36Epidural buprenorphine versus epidural morphine;37Intravenous buprenorphine versus intravenous morphine 22…”

“…Titration schedule or adequacy, or both, was unclear in the remaining eight studies. Apart from five studies which reported to have received commercial funding,24 25 27–29 it was unclear whether the remaining studies received such funding.…”

Rational Use of Sublingual Opioids in Palliative Medicine

“…41 It has subsequently been used by a variety of other routes including epidural, [42][43][44] subarachnoid, 45 subcutaneous, 46 intravenous, 47 intramuscular, 48,49 transdermal, [50][51][52][53][54][55][56] The use of buprenorphine for cancer pain has recently been reviewed. 57 Buprenorphine in cancer pain-chiefly as a new, transdermal formulation available in Europe and Australia-is acquiring a rapidly expanding evidence base of safety and efficacy.…”

Subarachnoid buprenorphine administered by implantable micropumps

“…It has been widely used, with good results, for the treatment of acute 4, 6, 18, 33 and chronic pain a9, 22,25,34 …”