Abstract
Patients with chronic non-cancer pain (CNCP) often use opioids for long periods of time. This may lead to opioid use disorder (OUD) and psychiatric symptoms: mainly depression and anxiety. The current study investigated the effect of buprenorphine/naloxone (BuNa) rotation on opioid misuse, craving, psychiatric symptoms and pain in patients with CNCP and OUD. Forty-three participants with CNCP and OUD were converted from a full mu-receptor agonist opioid (mean morphine equivalent dose: 328.3 mg) to BuNa, in an inpatient setting. Opioid misuse, craving, co-occurring psychiatric symptoms, and pain perception were determined at baseline and after a two-month follow-up, using the following self-report questionnaires: Current Opioid Misuse Measurement (COMM), Visual Analog Scale (VAS-craving and VAS-pain) and Depression, Anxiety and Stress Scale (DASS), respectively. VAS-craving and VAS-pain were also determined immediately after conversion. A total of 37 participants completed the protocol. The mean COMM decreased from 17.1 to 6.7 (F = 36.5; p < 0.000), the mean VAS-craving decreased from 39.3 to 5.3 (−86.6%; F = 26.5, p < 0.000), the mean DASS decreased from 12.1 to 6.6 (F = 56.3, p < 0.000), and the mean VAS-pain decreased from 51.3 to 37.2 (−27.4%, F = 3.3; p = 0.043). Rotation to BuNa in patients with CNCP and OUD was accompanied by reductions in (i) opioid misuse, (ii) opioid craving, (iii) the severity of co-occurring psychiatric symptoms, and (iv) self-reported pain. BuNa as opioid agonist treatment may therefore be a beneficial strategy in CNCP patients with OUD. The limited sample size and the observational nature of this study underline the need for the replication of the current findings in large-scale, controlled studies.
Highlights
Worldwide there has been a marked increase in opioid prescriptions for chronic noncancer pain (CNCP) since the mid-1990s [1,2]
Since the effects of BuNa OAT on opioid misuse, craving and psychiatric outcomes have hardly been studied in CNCP patients with co-occurring opioid use disorder (OUD), the aim of the current study was to explore the effectiveness of BuNa in patients with CNCP and OUD
The present study investigated the effects of rotation from full mu-opioid receptor agonists to BuNa, in patients with CNCP and OUD, on (i) current opioid misuse, (ii) opioid craving, (iii) psychiatric symptoms, and (iv) self-reported pain
Summary
Worldwide there has been a marked increase in opioid prescriptions for chronic noncancer pain (CNCP) since the mid-1990s [1,2]. Long-term opioid use is associated with numerous adverse effects, including constipation, respiratory depressions, sedation, reduced concentration, opioid use disorder (OUD) and opioid-related mortality [6,7,8,9]. Physical dependence may develop rapidly after the initiation of opioid use, leading to a tolerance for the analgesic effects of opioids, and withdrawal when opioids are not taken. Both opioid-induced hyperalgesia, characterized by an increased sensitivity to pain induced by full mu-receptor agonists, and tolerance for the analgesic effects of full mu-opioid receptor agonists, may contribute to a desire for increasing opioid doses [13,14]. Meta-analysis found a pooled incidence of OUD in approximately 4.7% of patients using opioids for pain relief [17]
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