Sublingual Buprenorphine Is Effective in the Treatment of Chronic Pain Syndrome

Abstract

Many patients with chronic pain have less than optimal therapeutic outcomes after prolonged treatment with opiate analgesics. Worsening of pain perception, functional capacity, and mood often result. Medical detoxification is often undertaken in this situation. Ninety-five consecutive patients (49 men and 46 women; age range, 26-84) with chronic noncancer pain (maldynia) were referred by local pain clinics for detoxification from long-term opiate analgesic (LTOA) therapy. All patients had failed treatment as manifest by increasing pain levels, worsening functional capacity, and, in 8%, the emergence of opiate addiction. Length of prior LTOA therapy ranged from 1.5 to 27 years (mean, 8.8 years). After a minimum of 12 hours of abstinence from all opiate analgesics, patients were given low doses of sublingual (SL) buprenorphine or buprenorphine/naloxone (Reckitt Benckiser). Maintenance dosing was individualized to treat chronic pain. Daily SL dose of buprenorphine ranged from 4 to 16 mg (mean, 8 mg) in divided doses. Mean duration of treatment is 8.8 months (range, 2.4-16.6 months). At clinic appointments, patients were assessed for pain reports, functional capacity, and mood inventory. Eighty-six percent of patients experienced moderate to substantial relief of pain accompanied by both improved mood and functioning. Patient and family satisfaction was robust. Only 6 patients discontinued therapy secondary to side effects and/or exacerbation of pain. In this open-label study, SL buprenorphine and buprenorphine/naloxone were well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to LTOA.

Buprenorphine Use: The International Experience

“…Reduction in chronic opioid-induced hyperalgesia requires long-term abstinence from opioid use. Interestingly, laboratory and open-label uncontrolled clinical evaluations suggest that buprenorphine can produce an antihyperalgesic state [143] and therefore could be helpful in the management of opioid-dependent patients with chronic, nonmalignant pain [144,145]. This may be related to the partial agonist profile of buprenorphine.…”

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…17 While buprenorphine has analgesic properties, it is not typically initiated, dosed, or directed toward pain relief in opioid-dependent persons. [21][22][23][24] Persistent pain is associated with negative substance use outcomes in persons receiving buprenorphine for opioid detoxification 25 or as maintenance treatment. 12 Unrelieved chronic pain contributes to early buprenorphine treatment termination.…”

The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone

“…Although an injectable formulation of buprenorphine is available in the United States for postsurgical pain and transdermal buprenorphine is prescribed in Europe for pain management, sublingual buprenorphine and Bup/Nx are not approved by the United States Food and Drug Administration for treating pain (Caplan and Southam, 1990). Nevertheless, the off-label use of sublingual buprenorphine (Subutex or Suboxone) to treat pain has been described in the clinical literature (Heit and Gourlay, 2008;Malinoff et al, 2005). These reports indicate that patients with pain who were responding poorly to other opioid analgesics were successfully treated with sublingual buprenorphine.…”