buprenorphine and Pain--Intractable

Individuals with chronic pain who use long-term opioid therapy (LTOT) are at risk of opioid use disorder and other harmful outcomes. Rotation to buprenorphine may be considered, but the outcomes of such rotation in this population have not been systematically reviewed.. To synthesize the evidence on rotation to buprenorphine from full μ-opioid receptor agonists among individuals with chronic pain who were receiving LTOT, including the outcomes of precipitated opioid withdrawal, pain intensity, pain interference, treatment success, adverse events or adverse effects, mental health condition, and health care use.. PubMed, CINAHL, Embase, and PsycInfo were searched from inception through November 3, 2020, for peer-reviewed original English-language research that reported the prespecified outcomes of rotation from prescribed long-term opioids to buprenorphine among individuals with chronic pain. Two independent reviewers extracted data as well as assessed risk of bias and study quality according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.. A total of 22 studies were analyzed, of which 5 (22.7%) were randomized clinical trials, 7 (31.8%) were case-control or cohort studies, and 10 (45.5%) were uncontrolled pre-post studies, which involved 1616 unique participants (675 female [41.8%] and 941 male [58.2%] individuals). Six of the 22 studies (27.3%) were primary or secondary analyses of a large randomized clinical trial. Participants had diverse pain and opioid use histories. Rationale for buprenorphine rotation included inadequate analgesia, intolerable adverse effects, risky opioid regimens (eg, high dose and/or sedative coprescriptions), and aberrant opioid use. Most protocols were adapted from protocols for initiating treatment in patients with opioid use disorder and used buccal or sublingual buprenorphine. Very low-quality evidence suggested that buprenorphine rotation was associated with maintained or improved analgesia, with a low risk of precipitating opioid withdrawal. Steady-dose buprenorphine was better tolerated than tapered-dose buprenorphine. Adverse effects were manageable, and severe adverse events were rare. Only 2 studies evaluated mental health outcomes, but none evaluated health care use. Limitations included a high risk of bias in most studies.. In this systematic review, buprenorphine was associated with reduced chronic pain intensity without precipitating opioid withdrawal in individuals with chronic pain who were receiving LTOT. Future studies are necessary to ascertain the ideal starting dose, formulation, and administration frequency of buprenorphine as well as the best approach to buprenorphine rotation.

Topics: Analgesics, Opioid; Buprenorphine; Drug Administration Schedule; Humans; Pain, Intractable

Refractory cancer pain that does not respond to standard opioid and/or co-analgesic therapy occurs in 10-20 % of patients. Risk factors include young age, neuropathic pain type, incident pain, psychological distress, previous opioid use, high tolerance, a history of addiction and impaired cognition. The management of patients with refractory pain remains a challenge. Treatment options include opioid manipulation (parenteral delivery, rotation, combination, methadone and buprenorphine), non-opioids and co-analgesics (paracetamol, non-steroidal anti-inflammatory agents, antidepressants and anticonvulsants), NMDA receptor antagonists, cannabinoids, lignocaine and corticosteroids. The evidence of benefit for any of these agents is weak, and each additional agent increases the risk of adverse events. Evidence-based guidelines cannot, therefore, be developed at present. New approaches are recommended including targeted opioid therapy, multimodal analgesia, a goal-oriented approach to pain management and increasing use of the multidisciplinary team and support services.

Topics: Acetaminophen; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents; Buprenorphine; Drug Therapy, Combination; Drug Tolerance; Humans; Methadone; Neoplasms; Pain Management; Pain, Intractable

Buprenorphine was not used widely in clinical practice over many years, mainly due to analgesic potency and clinical safety concerns based on misinterpreted animal data. Contrary to previous concerns, however, no analgesic ceiling effect and no antagonism of combined pure mu-opioid receptor agonists is seen within the therapeutic dose range. In recent studies, buprenorphine could be effectively and safely combined with full mu-agonists, and switching between buprenorphine and another opioid provided comparable pain relief based on equianalgesic doses. Moreover, buprenorphine exerts an antihyperalgesic effect, which is due -- at least in part -- to antagonistic activity at kappa-opioid receptors. Buprenorphine pharmacokinetics are not altered by advanced age or renal dysfunction. In addition, the risk of respiratory depression is lower than with other opioids including morphine, hydromorphone, methadone and fentanyl. Unlike morphine and fentanyl, there is no immunosuppressive activity with buprenorphine at therapeutic analgesic doses. Transdermal buprenorphine has significantly improved the clinical use of the drug, providing continuous buprenorphine release for up to 96 h. In clinical trials, patients receiving transdermal buprenorphine experienced significantly greater pain relief, better sleep, and a reduced need for rescue therapy, compared to placebo. Large-scale post-marketing studies have confirmed the effectiveness of transdermal buprenorphine in treating moderate-to-severe cancer and non-cancer pain including neuropathic syndromes. Finally, the comparably low incidence of CNS adverse events and constipation, and the possibility of use in severe renal dysfunction without a need for dose adjustment make buprenorphine well suited for chronic pain management in at-risk patients, such as diabetics, elderly or renally impaired individuals including those requiring haemodialysis.

Topics: Administration, Cutaneous; Analgesics, Opioid; Buprenorphine; Central Nervous System; Drug Interactions; Humans; Pain, Intractable; Receptors, Opioid; Renal Insufficiency; Treatment Outcome

Sublingual buphrenorphine is a unique opioid medication based on its pharmacokinetics and pharmacodynamic properties. It may be used "on label" as an alternative choice to methadone for the treatment of opioid addiction or "off-label" for the treatment of both acute and chronic pain. Because of high mu receptor affinity and resultant blockade, it has been suggested that this might interfere with the management of moderate to severe pain in patients on opioid agonist treatment. The following article will offer strategies and approaches to address some of these real and perceived challenges.

Topics: Acute Disease; Administration, Sublingual; Adult; Analgesics, Opioid; Buprenorphine; Chronic Disease; Drug Synergism; Female; Humans; Male; Middle Aged; Opioid-Related Disorders; Pain, Intractable; Receptors, Opioid

Patients with moderate to severe malignancy-related pain frequently require the use of opioid pharmacotherapy. Unfortunately, many cancer patients continue to be prescribed subtherapeutic doses of pain medications resulting in undo suffering and diminished quality of life. The choice of analgesic pharmacotherapy should be individualized and based on the intensity and etiology of pain reported by the patient. Health care providers must be able to readily quantify the relative analgesic potency when converting from one opioid to another or from one route of administration to another. Transdermal fentanyl is effective and well tolerated pharmacotherapy for the cancer pain patients. However, clinicians need to be cognizant that the U.S./U.K. manufacturer's recommendations for equilalagesic dosing of transdermal fentanyl may result in initial doses that produce subtherapeutic levels and unrelieved pain in some patients. A more aggressive dosing algorithm for transdermal fentanyl using a 2:1 (mg/day of oral morphine: mcg/hr of transdermal fentanyl) conversion ratio that considers both a review of the literature and clinical experience should help clinicians individualize cancer pain pharmacotherapy. Transdermal buprenorphine is now being prescribed in Europe and Australia for chronic and cancer pain management. Buprenorphine's mixed agonist/antagonist activity, dosage ceiling, and high affinity to the opiate receptor limits its use to those patients who do not already require large daily doses of opioids. Thus, buprenorphine may not be an appropriate medication for some patients with advanced unremitting cancer pain.

Topics: Administration, Cutaneous; Administration, Oral; Algorithms; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Drug Administration Schedule; Fentanyl; Humans; Neoplasms; Pain, Intractable; Palliative Care; Titrimetry

Buprenorphine is a low molecular weight, lipophilic, opioid analgesic. Recently, a transdermal matrix patch formulation of buprenorphine has become available in three dosage strengths designed to release buprenorphine at 35, 52.5 and 70 micro g/h over a 72-hour period. At least satisfactory analgesia with minimal requirement for rescue medication (50% of patients treated with transdermal buprenorphine, in two trials. Furthermore, despite the availability of rescue medication to all patients, those receiving transdermal buprenorphine tended to experience greater pain relief, reduced pain intensity and longer pain-free sleep. Transdermal buprenorphine was generally well tolerated. Systemic adverse events were typical of opioid treatment or were attributable to the underlying disease.

Topics: Administration, Cutaneous; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Pain; Pain, Intractable

Some sources suggest that significant misuse of opioid drugs exists among patients with chronic pain. However, the risk factors and motivation behind their abuse may differ from those of other opioid abusers. This study sought to examine the abuse liability of oxycodone among patients with chronic, non-malignant pain who met the DSM-IV criteria for opioid abuse. Eighteen opioid-dependent patients with chronic pain lived on an in-patient unit of the New York State Psychiatric Institute during the 7-week study. Participants were given oral oxycodone (0, 10, 20, 40, and 60 mg/70 kg) while maintained on various doses of sublingual buprenorphine/naloxone (Bup/Nx; 2/0.5, 8/2, and 16/4 mg/day). Doses of both medications were administered under double-blind conditions. Oxycodone produced an overall positive, but less robust, subjective profile than previously reported in recreational opioid users without pain. Furthermore, unlike our findings in recreational opioid users and more similar to effects in non-drug-abusing individuals, oxycodone failed to serve as a reinforcer. As for the maintenance drug, Bup/Nx produced a dose-related reduction in some of the effects of acutely administered oxycodone. These data suggest that sublingual Bup/Nx has the potential as an analgesic medication and further research should investigate its use in treating patients with chronic pain who abuse opioids.

Topics: Adult; Analgesia; Analgesics, Opioid; Buprenorphine; Double-Blind Method; Drug Synergism; Female; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Oxycodone; Pain, Intractable; Reinforcement Schedule

The purpose of this trial was to evaluate the effect of long-term treatment with oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine on nausea, emesis and constipation.. Randomly selected outpatients with cancer pain receiving one of the study medications were enrolled in a prospective, open-labeled, controlled trial (n=174). Mobility, pain, and gastrointestinal symptoms were assessed directly and per selected item on the ECOG (Eastern Cancer Oncology Group), EORTC (European Organisation for Research and Treatment of Cancer) questionnaires, NRS (Numerical Rating Scales), and analyzed statistically.. Demographic and medical data were comparable in all groups. Only 15% of patients suffered from constipation. 59% took the prescribed laxatives. The incidence of stool free periods >72 h was significantly higher with transdermal opioids (transdermal fentanyl: 22%; transdermal buprenorphine: 21%; oral hydromorphone: 2%; p=0.003). 21% of patients revealed nausea and emesis. The mean NRS for nausea (transdermal fentanyl:1.3; transdermal buprenorphine: 1.2; oral hydromorphone: 1.5; p=0.6), the consumption of antiemetics (transdermal fentanyl: 42%; transdermal buprenorphine: 33%; oral hydromorphone: 36%; p=0.6) and laxatives (transdermal fentanyl:53%; transdermal buprenorphine:66%; oral hydromorphone: 61%; p=0.2) did not differ significantly, in contrast to the score for emesis (transdermal fentanyl: 16%; transdermal buprenorphine:13%; oral hydromorphone: 33%; p=0.02). Morphine equivalent opioid doses differed (mg/d transdermal fentanyl: 183; transdermal buprenorphine: 89; oral hydromorphone: 143; p=0.001), because of obvious tolerance varying after long-term treatment.. Gastrointestinal symptoms of cancer pain patients undergoing an opioid therapy are related to multifactorial causes. Transdermal opioids showed no benefit over oral controlled-release hydromorphone with regard to gastrointestinal symptoms. The conversion ratios for transdermal fentanyl, transdermal buprenorphine, and oral hydromorphone did not accord to the literature, because of differing occurrences of opioid tolerance after long-term therapy.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Antiemetics; Buprenorphine; Cohort Studies; Constipation; Delayed-Action Preparations; Female; Fentanyl; Gastrointestinal Diseases; Humans; Hydromorphone; Laxatives; Male; Middle Aged; Nausea; Neoplasms; Pain, Intractable; Prospective Studies; Vomiting

Pain still afflicts most cancer patients, mainly in the metastatic phases, and under-treatment is well documented. Transdermal delivery systems (TDS) containing fentanyl or buprenorphine could potentiality have advantages over oral and parenteral routes, but evidence from comparative trials are scanty. In the framework of a wider initiative, an Outcome Research Study was carried out in Italy in 2006 to evaluate the effects of various analgesic options, particularly buprenorphine TDS.. This is a multicenter, open-label, prospective, nonrandomized study. Data were collected using a web-based standardized system, with a follow-up up of to 3 months. Pain intensity, the primary outcomes of the study, was measured using 11-point numerical rating scales from the Brief Pain Inventory.. One-hundred ten centers recruited 1801 cases, most of which (60%) were receiving a strong opioid at the time of inclusion. Of these, 257 had TDS buprenorphine as first choice. Of the remaining 709 patients who at the time of inclusion were not on a strong opioid, 325 changed to a strong opioid and in 43% it was TDS buprenorphine. During the follow-up, physicians had to increase the dosage to control pain (average increase between 16% and 17%). About 34% of patients had an improvement of at least 2 points in worst pain, 15% had a 20% improvement in pain relief, and 40% in satisfaction. Results were in line with those of patients receiving other World Health Organization-level III opioids.. Despite the limitations owing to the observational design, these findings may be useful to clinicians to judge the value of the drug under evaluation better and to help researchers design further comparative studies.

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Buprenorphine; Female; Humans; Italy; Karnofsky Performance Status; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Prospective Studies; Treatment Outcome

The aim of this study was to evaluate the effect and tolerability of low doses of transdermal (TD) buprenorphine patches in opioid-naive patients with cancer pain.. This was a nonrandomized, open-label, uncontrolled study in consecutive opioid-naive patients with advanced cancer and moderate pain. TD buprenorphine was initiated at a dose of 17.5 microg/h (0.4 mg/d), with patch changes every 3 days. Doses were then adjusted according to the clinical response. Pain intensity, opioid-related adverse effects, TD buprenorphine doses, and quality of life were monitored over 4 weeks. The time to dose stabilization and indexes of dose escalation were also calculated.. Thirty-nine consecutive patients completed all 4 weeks of the study. Low doses of TD buprenorphine were well tolerated and effective in these opioid-naive patients with cancer pain. Pain control was achieved within a mean of 1.5 days after the start of TD buprenorphine therapy. The mean TD buprenorphine dose was significantly increased from baseline beginning at 2 weeks after the start of therapy and had doubled by 4 weeks (P < 0.05). Pain intensity was significantly decreased from baseline beginning at 1 week and continuing through the remaining weekly evaluations (P < 0.05). The mean buprenorphine escalation index, calculated as a percentage and in milligrams, was 41.2% and 0.2 mg, respectively. Quality of life improved significantly over the study period (P = 0.007). There were no significant changes in opioid-related symptoms between weekly evaluations.. Observations from this study suggest that randomized, controlled, double-blind studies of TD buprenorphine 17.5 microg/h in opioid-naive patients with cancer pain may be warranted.

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Quality of Life

The management of intractable pain in chronic pancreatitis is difficult. A novel method for its relief is described.. Twelve patients were given a mixture of buprenorphine (0.3 mg) and blood (10-15 mL) into the epidural space.. All patients had pain relief lasting up to six months.. Epidural buprenorphine injection is a simple, safe and effective method for pain relief in chronic pancreatitis.

Topics: Adolescent; Adult; Analgesics, Opioid; Buprenorphine; Child; Chronic Disease; Female; Humans; Injections, Epidural; Male; Pain Measurement; Pain, Intractable; Pancreatitis; Time Factors; Treatment Outcome

The aim of the present study has been to assess the responsiveness of various types of chronic pain to opioids given i.v. and tested against placebo in a double-blind, randomized fashion. Pain classified as primary nociceptive was effectively alleviated (P greater than 0.001) while neuropathic deafferentation pain was not significantly influenced by morphine or equivalent doses of other opioids. Also 'idiopathic' pain, defined as chronic pain with no or little demonstrable pathology, failed to respond. The results were not related to whether the patients were regular users of narcotic analgesics or not. The outcome of our double-blind opioid test has proved useful to justify a continued, or discontinued, use of narcotic medication in individual patients. It may also support the indication and choice of invasive stimulation procedures (spinal cord or brain). The results of the study illustrate the misconception of chronic pain as an entity and highlight the importance of recognizing different neurobiological mechanisms and differences in responsiveness to analgesic drugs as well as to non-pharmacological modes of treatment. The opioid test has thus become a valuable tool in pain analysis and helpful as a guide for further treatment.

Topics: Analgesics; Buprenorphine; Chronic Disease; Endorphins; Female; Humans; Male; Morphine; Nervous System Diseases; Nociceptors; Pain; Pain Measurement; Pain, Intractable; Palliative Care; Transcutaneous Electric Nerve Stimulation

The analgesic efficacy and tolerability of a morphine agonist-antagonist buprenorphine are evaluated. The drug is compared to pentazocin. For this purpose, the drugs were randomly administered to 42 patients suffering from pain caused by advanced cancer. Buprenorphine demonstrated a significantly higher analgesic effect than pentazocin and was better tolerated.

Topics: Buprenorphine; Clinical Trials as Topic; Drug Evaluation; Female; Humans; Male; Morphinans; Neoplasms; Pain, Intractable; Pentazocine

Sublingual tablets of buprenorphine (Temgesic sublingual) were given in a controlled trial of 41 patients for 2804 patient-days. With a mean starting dose of 1.09 mg and a final dose of 1.53 mg buprenorphine daily there was a good pain-relieving effect. The interval between doses was six to eight hours. The trial did not reveal any direct pointers as to tolerance or addictiveness after long-term intake of the drug. Because of its effectiveness and good duration of action, as well as the absence of negative long-term effects, the drug can be recommended in the long-term management of cancer pain.

Topics: Buprenorphine; Clinical Trials as Topic; Drug Evaluation; Humans; Long-Term Care; Morphinans; Neoplasms; Pain, Intractable; Palliative Care

Topics: Adult; Aged; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Female; Humans; Male; Meperidine; Middle Aged; Morphinans; Morphine Derivatives; Neoplasms; Pain, Intractable; Palliative Care

1 Twenty-seven patients with moderate to severe chronic pain of malignant origin received buprenorphine (0.3 mg) and morphine (10 mg) intramuscularly in a double-blind, single dose within patient study. 2 Efficacy analysis demonstrated no significant differences in the peak analgesic effects or in the time to reach these effects. However, buprenorphine had a significantly longer duration of action than morphine. 3 Sedation was the most frequent unwanted effect with a similar incidence following each treatment. Buprenorphine was associated with a significantly higher incidence, greater severity, earlier onset, and longer duration of dizziness, nausea and vomiting than morphine. 4 Following both treatments there were small but significant decreases in pulse rate, blood pressure, and respiratory rate.

Topics: Adult; Aged; Buprenorphine; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine; Neoplasms; Pain, Intractable; Time Factors

The therapeutic value of buprenorphine was investigated in 31 patients suffering from moderate to severe cancer pain by intramuscular administration at the single doses of 0.2 mg and 0.3 mg in comparison with pentazocine 30 mg. Analgesic effect of buprenorphine 0.3 mg was significantly superior to buprenorphine 0.2 mg and pentazocine 30 mg. The duration of analgesia with buprenorphine was 9 hours at 0.2 mg and 11 hours at 0.3 mg, which were markedly longer than pentazocine's 6 hours. Side effects most commonly observed in the three groups were nausea, vertigo, oral dryness, urinary retention, vomiting, sweating, and headache. The frequency of side effects was 54.8% for buprenorphine 0.2 mg, 50.0% for buprenorphine 0.3 mg and 58.3% for pentazocine 30 mg respectively, indicating no significant difference between the three groups. Blood pressure, heart rate and respiratory rate did not change appreciably, thereby suggesting a little effect of buprenorphine on the respiratory and cardiovascular systems. Buprenorphine was found a useful or extremely useful in 58% at 0.2 mg and 87.5% at 0.3 mg. As the result it was concluded that buprenorphine could be valuable as an analgesic for cancer pain.

Topics: Adolescent; Adult; Aged; Blood Pressure; Buprenorphine; Female; Humans; Male; Middle Aged; Morphinans; Neoplasms; Pain, Intractable; Pentazocine; Pulse; Respiration

Buprenorphine is a chemically synthesized opioid characterized as the partial mu agonist and kappa antagonist, and transdermal buprenorphine patch will be considered useful as a strong analgesic with fewer psychological side effects in the treatment of chronic non-cancer pain. Use of transdermal buprenorphine should be limited for pain relief of intractable muscle skeletal pain that cannot be alleviated with other analgesics. To avoid severe complication and drug abuse or addiction, assessment of pain and medical history including drug dependence by medical team are important before administration of transdermal buprenorphine. Moreover, side effects such as nausea, vomiting, constipation, erythema and itching, loss of appetite should be treated appropriately. When transdermal buprenorphine is administered to chronic pain patients, physicians must examine the condition of patients regularly at an outpatient clinic. Moreover, decreasing and discontinuation of opioid including transdermal buprenorphine should always be considered during the treatment. Most important objective of chronic pain treatment is to improve QOL and ADL of patients.

Topics: Analgesics, Opioid; Buprenorphine; Chronic Pain; Humans; Pain, Intractable; Transdermal Patch

The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. Under this medication a sufficient pain reduction (median NRS 2-3) over a period of 135 days could be achieved. At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family.If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care.

Topics: Aged; Analgesics, Opioid; Buprenorphine; Combined Modality Therapy; Comorbidity; Disease Progression; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Femoral Neoplasms; Humans; Infusion Pumps, Implantable; Length of Stay; Male; Neoplasm Staging; Osteosarcoma; Pain Measurement; Pain, Intractable; Palliative Care; Treatment Outcome

The aim was to study the introduction of the new low dose transdermal buprenorphine (LD-TD-BUP) in Norway, particularly with regard to former use and co-medication with other potentially addictive drugs. The nationwide Norwegian Prescription Database contains information on all prescription drugs dispensed to individual non-institutionalised patients, and we may follow all individuals who received LD-TD-BUP (Norspan) after marketing on the Norwegian market on 15/11/05. We studied all prescriptions of opioids and other potentially addictive drugs to patients receiving at least two LD-TD-BUP prescriptions during 2004-2006. Poisson regressions were run with concomitant use of addictive drugs (yes, no) as the endpoint. Overall, 1884, non cancer individuals received at least two prescription of LD-TD-BUP. Of these 91.7% received prescriptions of other opioids and 58.6% of them had also been prescribed benzodiazepines/carisoprodol before the prescription of LD-TD-BUP. Of the LD-TD-BUP users who received more than one prescription, 60% co-medicated with at least one other potentially addictive drug, and 24% with at least two. In the multivariate analysis, the variables associated with a higher likelihood of using co-medicated drugs were: previous use of benzodiazepines/carisoprodol relative risk RR=16.7 (95% CI 10.4-26.9), previous use of opioids RR=4.0 (1.9-8.7) and younger age 20-40 years RR=1.9 (1.6-2.3). So far, it is questionable whether the introduction of LD-TD-BUP actually has stabilised opioids consumption or whether it has complicated and increased the consumption of potentially addictive drugs.

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Anti-Anxiety Agents; Benzodiazepines; Buprenorphine; Carisoprodol; Databases, Factual; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Drug Utilization; Drug Utilization Review; Female; Humans; Male; Middle Aged; Muscle Relaxants, Central; Norway; Pain, Intractable; Practice Patterns, Physicians'; Registries; Risk Factors; Substance-Related Disorders

Acute pain is a common symptom experienced after spinal cord injury (SCI). The presence of this pain calls for treatment with analgesics, such as buprenorphine. However, there are concerns that the drug may exert other effects besides alleviation of pain. Among those reported are in vitro changes in gene expression, apoptosis, and necrosis. In this investigation, the effect of buprenorphine was assessed at the molecular, behavioral, electrophysiological, and histological levels after SCI. Rats were injured at the T10 thoracic level using the NYU impactor device. Half of the animals received buprenorphine (0.05 mg/kg) for 3 consecutive days immediately after SCI, and the other half were untreated. Microarray analysis (n = 5) was performed and analyzed using the Array Assist software. The genes under study were grouped in four categories according to function: regeneration, apoptosis, second messengers, and nociceptive related genes. Microarray analysis demonstrated no significant difference in gene expression between rats treated with buprenorphine and the control group at 2 and 4 days post-injury (DPI). Experiments performed to determine the effect of buprenorphine at the electrophysiological (tcMMEP), behavioral (BBB, grid walking and beam crossing), and histological (luxol staining) levels revealed no significant difference at 7 and 14 DPI in the return of nerve conduction, functional recovery, or white matter sparing between control and experimental groups (p > 0.05, n = 6). These results show that buprenorphine (0.05 mg/kg) can be used as part of the postoperative care to reduce pain after SCI without affecting behavioral, physiological, or anatomical parameters.

Topics: Analgesics, Opioid; Animals; Apoptosis; Buprenorphine; Disease Models, Animal; Evoked Potentials, Motor; Female; Gait Disorders, Neurologic; Gene Expression Regulation; Locomotion; Nerve Regeneration; Nerve Tissue Proteins; Neural Conduction; Nociceptors; Oligonucleotide Array Sequence Analysis; Pain, Intractable; Rats; Rats, Sprague-Dawley; Recovery of Function; Second Messenger Systems; Spinal Cord Injuries; Treatment Outcome

The aim of this study was to confirm that the concomitant presence of transdermal fentanyl (TTS FE) and buprenorphine (TTS BU) may be feasible without important consequences, using doses presumed to be equianalgesic. A prospective "N of 1" study was carried out in a sample of volunteers with cancer pain receiving stable doses of TTS FE or TTS BU, with adequate pain and symptom control. In the study design, each patient provided data before and after a switch from one opioid to the other and then back to the previous one. Sixteen patients receiving daily stable doses of 0.6 or 1.2mg of TTS FE were switched to TTS BU using an FE-BU ratio of 0.6-0.8. After three days, the TTS BU patch was removed and TTS FE patch was placed for another three days. Six patients receiving TTS BU were switched to TTS FE and then rotated back to TTS BU with the same dosing considerations. No statistical differences in changes in pain and symptom intensity during switching and between the two different sequences were observed. No significant changes in rescue doses of oral morphine were reported at the same intervals. Cancer patients receiving stable doses of TTS FE or TTS BU can be safely switched to the alternative transdermal opioid. Further studies should be performed to gather data about the use of TTS BU with other opioids, at different doses, and in different clinical conditions.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Analgesics, Opioid; Buprenorphine; Female; Fentanyl; Humans; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Prospective Studies

Previous studies have suggested that buprenorphine may have a low association with tolerance development compared with other strong opioids. In a previous study by our group, mean cohort and intraindividual dosage increases over an entire course of treatment and on a per-day basis were significantly lower with transdermal (TD) buprenorphine than with TD fentanyl. However, no information concerning the relationship between qualitative and quantitative dose changes is available.. The aim of this study was to compare TD buprenorphine and TD fentanyl with respect to dosage increases, dosage stability, and the nature of dosage changes.. This retrospective analysis used data from the IMS Disease Analyzer-Mediplus database, which contains patient-related data documented by 400 medical practices in Germany. Data from patients with noncancer or cancer pain treated with TD buprenorphine or TD fentanyl for at least 3 months between May 2002 and April 2005 were analyzed. Daily dosages were directly determined from the prescribed patch strength, taking into account the possibility of multiple patches applied simultaneously. To determine dosage stability, patients were classified based on the type of dosage change (stable, increase, alternating, or decrease) of the prescribed dosages. From the prescribed daily dosages, mean percentage increases were calculated on a per-patient basis for the entire treatment period and per day, and these were assessed in relation to the type of dosage change.. In total, 631 patients with noncancer pain and 605 patients with cancer pain were included in the analysis (782 women, 454 men; mean age, 76.3 years [range, 29-100 years]). Treatment indications included osteoarthritis, low back pain, osteoporosis (noncancer groups), and neoplasm (cancer groups). Patients had similar analgesic premedication requirements based on steps 1 to 3 of the World Health Organization analgesic ladder. Comedication requirements for breakthrough pain were also similar between the TD buprenorphine and TD fentanyl groups. The mean percentage increases per day were 0.10% (TD buprenorphine) and 0.25% (TD fentanyl) in the noncancer groups and 0.19% (TD buprenorphine) and 0.47% (TD fentanyl) in the cancer groups (both, P < 0.05). A significantly larger proportion of patients receiving TD buprenorphine had stable dosages over the entire treatment period compared with patients receiving TD fentanyl (noncancer groups: 56.9% vs 41.6%; cancer groups: 50.0% vs 26.2% [both, P < 0.05]). Compared with TD buprenorphine, the proportion of patients with alternating dosage changes was significantly greater in patients receiving TD fentanyl (noncancer groups: 22.7% vs 13.1%; cancer groups: 30.6% vs 11.8% [both, P < 0.05]).. In this retrospective data analysis, compared with TD buprenorphine, the increase in mean daily dosage was significantly greater in patients treated with TD fentanyl. Also, compared with TD buprenorphine, alternating dosage changes were seen in a significantly greater proportion of patients receiving TD fentanyl. On the other hand, a significantly greater proportion of patients treated with TD buprenorphine had stable dosages over their entire treatment periods.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Female; Fentanyl; Humans; Male; Middle Aged; Neoplasms; Pain; Pain, Intractable; Retrospective Studies

A new method for administration of opiates into the ventriculo-cisternal system for intractable pain due to cancer is presented. Five patients suffering from such pain underwent the permanent implantation of a subcutaneous reservoir connected to a thin catheter inserted into the trigeminal cistern. The indications are those of the intraventricular way. Percutaneous trigeminal opiates administration (PTO) proved to be a valid and simple alternative method to intrathecal and intraventricular morphine.

Topics: Analgesia; Buprenorphine; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Palliative Care; Trigeminal Ganglion

This report concerns 23 patients, the majority of whom are suffering from low back and chest pain caused by chest, urological or gynaecological cancer. These patients were treated with subarachnoid buprenorphine, administered in a single bolus or by slow infusion from micropumps, at a daily dose adapted to patients need (0.06-0.15 mg). The painful symptomatology was successfully controlled in all the cases treated, allowing the patients to live a virtually normal life. In no cases was respiratory depression or tolerance observed.

Topics: Adult; Aged; Buprenorphine; Drug Administration Schedule; Female; Humans; Infusion Pumps, Implantable; Male; Middle Aged; Neoplasms; Pain, Intractable; Subarachnoid Space; Thermography

The continuous subcutaneous infusion of buprenorphine, a new approach to the relief of severe cancer pain, has been carried out using a portable infusion pump. The efficacy of this method was examined in 30 patients by visual analogue scale. An infusion rate of 4 micrograms/kg/day following intramuscular administration of 0.004 micrograms/kg gave satisfactory pain relief without serious complications. The minimum effective blood concentration was not detectable by high-performance liquid chromatography. Advantages of this therapy are its simplicity, applicability in many types of cancer, multiple sites of administration, and easier training on the part of health personnel.

Topics: Adult; Aged; Blood Pressure; Buprenorphine; Female; Humans; Infusion Pumps; Injections, Subcutaneous; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable

Topics: Administration, Sublingual; Aged; Buprenorphine; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pain, Intractable

The efficacy of continuous subcutaneous infusion of buprenorphine for the treatment of terminal cancer pain was studied. Continuous subcutaneous administration of 4-8 micrograms/kg/day of buprenorphine, examined by the visual analogue scale was revealed to have satisfactory analgesic potency for control of every type of terminal cancer. This therapy can be undertaken by any member of the medical staff because of its safety and simplicity. The indications for this method are almost unlimited when the subcutaneous tissue can absorb the drug at a constant rate. Continuous subcutaneous buprenorphine administration via a portable infusion pump allows patients with severe pain from cancer the opportunity to move about freely.

Topics: Buprenorphine; Humans; Injections, Subcutaneous; Morphinans; Neoplasms; Pain, Intractable

The incidence of the Pancoast syndrome ranges from 2 to 5% of patients with lung cancer. We treated 20 cases between 1979 and 1984 with 29 procedures including percutaneous cordotomy, selective posterior radiculotomy, decompressive laminectomy, central administration of opiates, and TENS. Selective posterior radiculotomy gave the best pain relief.

Topics: Buprenorphine; Follow-Up Studies; Humans; Injections, Spinal; Laminectomy; Morphine; Pain, Intractable; Pancoast Syndrome; Spinal Cord; Spinal Nerve Roots

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2-290 mg) or 0.86 mg buprenorphine (range 0.15-7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1-700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 510 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.

Topics: Adult; Aged; Anesthesia, Epidural; Buprenorphine; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Neoplasms; Pain, Intractable

Buprenorphine sublingual tablets (0.2 mg) were investigated in therapy of cancer pain. In 67 patients there was a good analgetic effect in 60%, even in those cases treated with other opiates before. The induction time was quite long (60 min.) but is no problem in chronic administration. Effective pain relief was obtained even in final stages of cancer. The mean daily dose of buprenorphine had been 1.2-1.7 mg, the mean duration of analgesia being 6-8 hours with a single dose of 0.2-1.0 mg buprenorphine. Typical opiate-side-effects were registered and well tolerated after some days' treatment. There was no respiratory depression. Buprenorphine sublingual tablets are certainly a good alternative in orally available opioids.

Topics: Administration, Oral; Adult; Aged; Buprenorphine; Female; Humans; Long-Term Care; Male; Middle Aged; Morphinans; Neoplasms; Pain, Intractable

Previous to October 1st, 1981, 8 major Danish anaesthesiological departments registered 105 patients treated with extradural opiates for a period of more than 7 days, partially or completely on outpatient basis. Ninety-four suffered from painful malignant diseases and 11 patients from various painful benign diseases. The mean period of treatment was 65 days (range: 7-283 days) and of these 49 days (2-266 days) as outpatients. The total number of inserted epidural catheters was 215, equivalent of an average of 2 per patient (range 1-5). Reasons for removing an extradural catheter were injection-related pain, difficulty in injecting the desired volume, and displacement of catheter. Morphine chloride, in a solution of 0.4 mg/ml of normal saline, was the main choice as analgesic agent (90 patients). The mean daily dose of this drug totalled 12.6 +/- 4.8 mg (S.D.) (range: 4-30 mg) distributed as 2.7 +/- 0.9 (S.D.) (range: 1-6) daily injections. Twelve patients were treated with buprenorphine extradurally. Satisfactory pain relief was achieved for 70 patients (67%) who managed with extradural opiates as sole analgesic treatment. One patient developed septicaemia with a non-fatal outcome probably originating from some other focus. Apart from this no serious side effects were reported. Medically unskilled persons or relatives were responsible for instillation of all extradural opiates with 42 patients and partially responsible with 14 patients. Eleven patients managed injections without assistance. District nurses took care of medication for 46 patients, aided by a general practitioner in 5 cases. Three patients were supplied with continuous extradural infusion by means of a Mill Hill microinfusion pump.

Topics: Ambulatory Care; Analgesia; Buprenorphine; Catheters, Indwelling; Denmark; Epidural Space; Humans; Injections; Morphinans; Morphine; Pain, Intractable

Topics: Buprenorphine; Humans; Morphinans; Neoplasms; Pain, Intractable; Palliative Care; Postoperative Period; Respiration, Artificial

Topics: Buprenorphine; Humans; Injections, Intramuscular; Morphinans; Neoplasms; Pain, Intractable