An alternative way of managing acute pain in patients who are in buprenorphine opioid substitution therapy programs

Huxtable, Christine; Macintyre, Pamela E.

doi:10.1097/eja.0b013e32836394fe

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…This approach is based on a theoretical understanding of buprenorphine pharmacology that is rational. However, clinical retrospective studies of patients receiving buprenorphine maintenance therapy found that morphine responses were not different compared with methadone-maintained individuals [47, 179]. These authors felt that buprenorphine-maintained individuals do not need to be switched off their maintenance opioid, an approach that has also been advocated by others [180].…”

Section: Miscellaneous But Important Topicsmentioning

confidence: 99%

Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option

Davis

Pasternak

Behm

2018

Drugs

104

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The buprenorphine receptor binding profile is unique in that it binds to all three major opioid receptors (mu, kappa, delta), and also binds to the orphan-like receptor, the receptor for orphanin FQ/nociceptin, with lower affinity. Within the mu receptor group, buprenorphine analgesia in rodents is dependent on the recently discovered arylepoxamide receptor target in brain, which involves a truncated 6-transmembrane mu receptor gene protein, distinguishing itself from morphine and most other mu opioids. Although originally designed as an analgesic, buprenorphine has mainly been used for opioid maintenance therapy and only now is increasingly recognized as an effective analgesic with an improved therapeutic index relative to certain potent opioids. Albeit a second-, third-, or fourth-line analgesic, buprenorphine is a reasonable choice in certain clinical situations. Transdermal patches and buccal film formulations are now commercially available as analgesics. This review discusses buprenorphine pharmacodynamics and pharmacokinetics, use in certain populations, and provides a synopsis of systematic reviews and randomized analgesic trials. We briefly discuss postoperative management in patients receiving buprenorphine maintenance therapy, opioid equivalence to buprenorphine, rotations to buprenorphine from other opioids, and clinical relevance of buprenorphine-related QTc interval changes.

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Section: Miscellaneous But Important Topicsmentioning

confidence: 99%

Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option

Davis

Pasternak

Behm

2018

Drugs

104

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“…60 Therefore, one can add a potent opioid for acute pain in patients on low doses or moderate doses of buprenorphine. [61][62][63][64] At high doses, there may be a loss of potent opioid analgesia although this is a controversial issue. 62,63 It is less clear when treating individuals on maintenance buprenorphine for addiction but several case series suggest that potent opioids do produce analgesia even when patients are on high doses of buprenorphine and 80% of m receptors are occupied.…”

Section: Nalbuphinementioning

confidence: 99%

“…[61][62][63][64] At high doses, there may be a loss of potent opioid analgesia although this is a controversial issue. 62,63 It is less clear when treating individuals on maintenance buprenorphine for addiction but several case series suggest that potent opioids do produce analgesia even when patients are on high doses of buprenorphine and 80% of m receptors are occupied. 65 The high affinity for m receptors, activation of receptors at low concentrations, long receptor dwell time, and interactions with different m receptor subtypes explain the cognitive dissonance, which exists between the fact that it is a partial agonist but acts clinically as a very potent analgesia equal to a full agonist like fentanyl.…”

Section: Nalbuphinementioning

confidence: 99%

What Parenteral Opioids to Use in Face of Shortages of Morphine, Hydromorphone, and Fentanyl

Davis

McPherson

Mehta

et al. 2018

Am J Hosp Palliat Care

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“…Cancer patients with breakthrough pain receiving transdermal buprenorphine from 35-70 µg/h responded well to an oral morphine to transdermal buprenorphine ratio of 75:1 [40]. Additionally, those using high-dose buprenorphine for maintenance therapy did not need to be switched off this opioid for methadone, as the patients morphine responses were not different between the two groups [41].…”

Section: Route Of Administrationmentioning

confidence: 96%

An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine

Pande,

Arnet,

Piper

2023

Pharmaceuticals

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The goal of this review is to provide a recent examination of the pharmacodynamics as well as pharmacokinetics, misuse potential, toxicology, and prenatal consequences of buprenorphine. Buprenorphine is currently a Schedule III opioid in the US used for opioid-use disorder (OUD) and as an analgesic. Buprenorphine has high affinity for the mu-opioid receptor (MOR), delta (DOR), and kappa (KOR) and intermediate affinity for the nociceptin (NOR). Buprenorphine’s active metabolite, norbuprenorphine, crosses the blood–brain barrier, is a potent metabolite that attenuates the analgesic effects of buprenorphine due to binding to NOR, and is responsible for the respiratory depressant effects. The area under the concentration curves are very similar for buprenorphine and norbuprenorphine, which indicates that it is important to consider this metabolite. Crowding sourcing has identified a buprenorphine street value (USD 3.95/mg), indicating some non-medical use. There have also been eleven-thousand reports involving buprenorphine and minors (age < 19) at US poison control centers. Prenatal exposure to clinically relevant dosages in rats produces reductions in myelin and increases in depression-like behavior. In conclusion, the pharmacology of this OUD pharmacotherapy including the consequences of prenatal buprenorphine exposure in humans and experimental animals should continue to be carefully evaluated.

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An alternative way of managing acute pain in patients who are in buprenorphine opioid substitution therapy programs

Cited by 6 publications

References 6 publications

Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option

Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option

What Parenteral Opioids to Use in Face of Shortages of Morphine, Hydromorphone, and Fentanyl

An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine

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