Managing long-term high-dose prescription opioids in patients with non-cancer pain: The potential role of sublingual buprenorphine

Chong, Joan; Frei, Matthew; Lubman, Dan I.

doi:10.31128/ajgp-07-19-4994

Cited by 3 publications

(2 citation statements)

References 23 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To reduce clinical heterogeneity, we grouped interventions into five categories based on their clinical approach to the problem of long term opioid treatment: pain self-management 34 35 ; complementary and alternative medicine 36 ; pharmacological and biomedical devices and interventions 37 38 ; opioid replacement treatment 39 40 41 ; and deprescription methods 42 ( table 1 ). Where interventions included elements from multiple categories, we assigned the study to the category deemed most applicable to its principal mechanism.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Avery

McNeilage

Stanaway

et al. 2022

BMJ

View full text Add to dashboard Cite

ObjectiveTo review interventions to reduce long term opioid treatment in people with chronic non-cancer pain, considering efficacy on dose reduction and discontinuation, pain, function, quality of life, withdrawal symptoms, substance use, and adverse events.DesignSystematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions.Data sourcesMedline, Embase, PsycINFO, CINAHL, and the Cochrane Library searched from inception to July 2021. Reference lists and previous reviews were also searched and experts were contacted.Eligibility criteria for study selectionOriginal research in English. Case reports and cross sectional studies were excluded.Data extraction and synthesisTwo authors independently selected studies, extracted data, and used the Cochrane risk-of-bias tools for randomised and non-randomised studies (RoB 2 and ROBINS-I). Authors grouped interventions into five categories (pain self-management, complementary and alternative medicine, pharmacological and biomedical devices and interventions, opioid replacement treatment, and deprescription methods), estimated pooled effects using random effects meta-analytical models, and appraised the certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation).ResultsOf 166 studies meeting inclusion criteria, 130 (78%) were considered at critical risk of bias and were excluded from the evidence synthesis. Of the 36 included studies, few had comparable treatment arms and sample sizes were generally small. Consequently, the certainty of the evidence was low or very low for more than 90% (41/44) of GRADE outcomes, including for all non-opioid patient outcomes. Despite these limitations, evidence of moderate certainty indicated that interventions to support prescribers’ adherence to guidelines increased the likelihood of patients discontinuing opioid treatment (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1), and that these prescriber interventions as well as pain self-management programmes reduced opioid dose more than controls (intervention v control, mean difference –6.8 mg (standard error 1.6) daily oral morphine equivalent, P<0.001; pain programme v control, −14.31 mg daily oral morphine equivalent, 95% confidence interval −21.57 to −7.05).ConclusionsEvidence on the reduction of long term opioid treatment for chronic pain continues to be constrained by poor study methodology. Of particular concern is the lack of evidence relating to possible harms. Agreed standards for designing and reporting studies on the reduction of opioid treatment are urgently needed.Review registrationPROSPERO CRD42020140943.

show abstract

Section: Methodsmentioning

confidence: 99%

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Avery

McNeilage

Stanaway

et al. 2022

BMJ

View full text Add to dashboard Cite

show abstract

“…Its mixed partial agonism and agonist–antagonist profile provide a superior safety profile (reduced rates of sedation and respiratory depression) compared with full opioid agonists. This and its long half-life make buprenorphine useful in opioid agonist treatment (OAT) (2) for opioid use disorder and chronic pain (4). Buprenorphine can be administered via the sublingual, transdermal, subcutaneous, and intravenous routes (1).…”

Section: Introductionmentioning

confidence: 99%

A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine

Katz

Lloyd‐Jones

Demediuk

et al. 2022

Journal of Patient Experience

View full text Add to dashboard Cite

In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.

show abstract

Fentanyl

2021

Reactions Weekly

View full text Add to dashboard Cite

Managing long-term high-dose prescription opioids in patients with non-cancer pain: The potential role of sublingual buprenorphine

Cited by 3 publications

References 23 publications

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine

Fentanyl

Contact Info

Product

Resources

About