Buprenorphine and pain treatment in pediatric patients: an update

Abstract

IntroductionThe usual management of moderate to severe pain is based on the use of opioids. Buprenorphine (BPN) is an opioid with an analgesic potency 50 times greater than that of morphine. It is widely used in various pain models and has demonstrated efficacy and safety in adult patients; however, there are insufficient clinical trials in pediatric populations.PurposeThe aim of this study was to perform an updated meta-analysis on the implementation of BPN in the treatment of pain in the pediatric population.MethodsA bibliographic search was carried out in different biomedical databases to identify scientific papers and clinical trials with evidence of BPN use in children and adolescents.ResultsA total of 89 articles were found, of which 66 were selected. Analysis of these items revealed additional sources, and the final review included a total of 112 publications.ConclusionFew studies were found regarding the efficacy and safety of BPN use in children. In recent years, the use of this drug in the pediatric population has become widespread, so it is imperative to perform clinical trials and pharmacological and pharmacovigilance studies, which will allow researchers to develop dosage schemes based on the evidence and minimize the risk of adverse effects.

Buprenorphine–cannabis interaction in patients undergoing opioid maintenance therapy

“…The partial μ-opioid agonist buprenorphine is widely used for opioid maintenance therapy (OMT). Its long elimination half-life is subject to great inter-individual variation [5][6][7]. Elimination includes N-dealkylation to norbuprenorphine by CYP3A4, and to a lesser extent by CYP2C8, glucuronidation and biliary excretion [8].…”

“…Elimination includes N-dealkylation to norbuprenorphine by CYP3A4, and to a lesser extent by CYP2C8, glucuronidation and biliary excretion [8]. Approximately 10-30% are excreted via the urinary tract [5,7,9]. As norbuprenorphine has a much longer elimination half-life than buprenorphine, patient adherence to the therapy regimen is associated with metabolite-to-parent drug concentration ratios greater than 1 in the presence of normal hepatic metabolism [10].…”

Buprenorphine versus Morphine in Paediatric Acute Pain: A Systematic Review and Meta-Analysis

“…Pain is associated with higher levels of anxiety, development of avoidance behaviour, and increased levels of both patient and parental distress [ 1 ]. Severe acute pain has been shown to lead to the development of chronic pain in up to twenty percent of children involved [ 4 ].…”

“…Effective management of acute pain typically involves a multimodal analgesic approach, with opioids a mainstay for moderate to severe pain [ 4 , 5 ]. Common side effects of opioids include sedation, nausea, constipation, dizziness, and pruritus [ 1 ].…”

“…Buprenorphine is a semisynthetic, partial mu-opioid receptor agonist that has theoretical safety and efficacy advantages over pure opioid agonists, through its proposed ceiling effect on respiratory depression but not analgesic effect [ 4 ]. Whether this ceiling effect is reproduced in the paediatric population is controversial, with few studies demonstrating the safety and efficacy of buprenorphine in this population [ 4 , 6 ].…”