Transdermal buprenorphine – a critical appraisal of its role in pain management

Abstract

This paper reviews the current clinical data for the role of transdermal buprenorphine (BUP TDS) in the treatment of diverse acute and chronic pain syndromes. Literature searches were carried out using PubMed (1988 to June 2009). The published findings seem to support hypotheses regarding the rather unique analgesic mechanisms of buprenorphine as compared with pure μ-opioids like morphine and fentanyl. However, the exact mechanism of this analgesic efficacy still remains largely unknown despite recent advances in preclinical pharmacological studies. Such assessments have demonstrated the sustained antihyperalgesic effect of buprenorphine in diverse animal pain models. These findings are supported in a growing number of clinical studies of oral, intrathecal, intravenous, and Bup TDS. This review paper focuses almost entirely on the clinical experience concerning the transdermal administration of buprenorphine, although preclinical aspects are also addressed in order to provide a complete picture of the unique pharmacological properties of this analgesic drug. Mounting evidence indicates the appropriateness of Bup TDS in the treatment of diverse acute and chronic pain syndromes which have been less or not responsive to other opioids. Additionally, BUP TDS seems to hold great promise for other difficult-to-treat (pain) conditions, such as patients in the intensive care setting. However, its use is somewhat tempered by the occurrence of local skin reactions which have been shown to be often therapy resistant. Further studies are certainly warranted to identify even more precisely the clinical syndromes that are most sensitive to buprenorphine treatment, and to compare buprenorphine to other opioids in head-to-head trials of acute and chronic pain conditions.

Safety and efficacy of transdermal buprenorphine versus oral tramadol for the treatment of post-operative pain following surgery for fracture neck of femur: A prospective, randomised clinical study

“…Transdermal buprenorphine has been used in the management of chronic cancer and non-cancer pains for few years. [11] It has been shown to be safe for long-term use even in elderly without much change in pharmacokinetics. [1213] It can be safely used in patients with decreased renal reserve and even end-stage renal failure.…”

Management of pain using transdermal patches

“…It produces a ceiling side effect for respiratory depression, especially when combined with CNS depressants [22].…”

Nanofibers Used for the Delivery of Analgesics

“…However, this method is inappropriate for managing acute pain because of the specific kinetics of slow onset, delayed absorption after patch removal, lengthy halflife and thus slow offset [69,70]. Ngawhirunpat et al [54] used electrospun polyvinyl alcohol (PVA) nanofiber mats loaded with meloxicam as a transdermal drug delivery system.…”