Buprenorphine In Cancer Pain Research Articles

When Buprenorphine is Not Enough: A Case of Transitioning Off of Buprenorphine in Cancer Pain and Opioid Use Disorder

When Buprenorphine is Not Enough: A Case of Transitioning Off of Buprenorphine in Cancer Pain and Opioid Use Disorder

Buprenorphine for Cancer Pain in Patients With Nonmedical Opioid Use: A Retrospective Study at a Comprehensive Cancer Center.

Outpatients with cancer commonly have nonmedical opioid use (NMOU) behaviors and use opioids to dull emotional and existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. A retrospective review was done in patients who were prescribed buprenorphine for cancer pain. Pain scores were reported on a Likert pain scale of 1 to 10. Nonmedical opioid use was defined as patients taking opioids for emotional pain at or above the maximum prescribed amount. For 16 patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 (Standard deviation (Std) 1.6), and the mean pain score on follow-up post-buprenorphine (pain post) was 6.1 (Std 2.3) with a reduction in mean pain score (pain change) of -2.0 (Std 2.9, P = .059). Those patients without NMOU had a pain prescore of 9.5 (Std 1.0) and pain post of 4.3 (Std 2.5) with a mean pain change of -5.0 (Std 1.7, P = .20). The mean pain change in those with chemical coping (-1.3/Std 2.7), illicit drug use (-2.8/Std 1.0), or psychiatric comorbidity (-2.4/Std 2.7) were reduced after buprenorphine, however, not statistically significant. Outpatient rotation to buprenorphine was well tolerated. The pain score in those patients without NMOU was significantly lower after rotation to buprenorphine than those with NMOU. We deduce that in those with NMOU, it is more challenging to achieve pain relief with buprenorphine. Overall, for all patients, rotation to buprenorphine resulted in a marginally significantly reduced pain score.

Chemical coping and efficacy of buprenorphine for cancer pain.

200 Background: The management of cancer-related pain is challenging in the age of the opioid epidemic. Patients who struggle with substance misuse or chemical coping use these substances to dull emotional and or existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. Methods: We conducted a retrospective review of patients in an outpatient palliative care clinic at a tertiary comprehensive cancer center who were prescribed buprenorphine for cancer pain. Total oral morphine equivalent (OME), as well as use of adjuvant non-opioid neuropathic pain medication, were assessed prior to transition to buprenorphine. Chemical coping behavior was defined as patients taking opioids for emotional pain in excess of the maximum prescribed amount. Pain scores were reported before and after buprenorphine administration using a Likert pain scale (0-10). Patients were also assessed for the presence of withdrawal symptoms after transition to buprenorphine. Results: Patients were predominantly female (75%), slightly more than half had a psychiatric diagnosis (56%), a majority were on non-opioid neuropathic pain medication (93%), and the majority were identified as chemical copers (75%). For all patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 and the mean pain score on follow up post buprenorphine (pain post) was 6.1, with a reduction in mean pain score (pain change) of -2.0 (p = 0.059). Patients without chemical coping behaviors reported a significantly greater reduction in pain scores compared to patients with chemical coping (pain change -5.0 vs -1.3, p = 0.02). Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain scores. Only a small number of patients reported withdrawal symptoms (6%) during buprenorphine transition. Conclusions: Rotation to buprenorphine led to a trend of reduction in pain score, though not statistically significant. Patients without chemical coping experienced greater reductions in pain score than those with chemical coping behavior. Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain.

Buprenorphine for cancer pain: is it ready for prime time?

Buprenorphine (BUP) is a semisynthetic derivative of the opium alkaloid thebaine found in the poppy Papaver somniferum. Its chemical structure contains the morphine structure but differs by having a cyclopropylmethyl group. Buprenorphine is a potent µ opioid agonist. Buprenorphine undergoes extensive first-pass metabolism in the liver and gut. The development of a transdermal BUP formulation in 2001 led to its evaluation in cancer pain. This article provides the practitioner with an update on the current role of BUP in cancer care. It highlights data suggesting effectiveness in various types of cancer pain. The article reviews pharmacology, routes of administration, adverse effects, drug interactions, and cost considerations.

Opioid Antagonists

Opioid Antagonists

Efficacy and Safety of Transdermal Buprenorphine: A Randomized, Placebo-Controlled Trial in 289 Patients with Severe Cancer Pain

Strong opioids are recommended for treating severe cancer pain in the advanced stages of the disease. Few data are available concerning the efficacy of buprenorphine in cancer pain. We compared transdermal buprenorphine 70 μg/h (BUP TDS) to placebo in an enriched design study. Opioid-tolerant patients with cancer pain requiring strong opioids in the dose range of 90–150 mg/d oral morphine equivalents entered a two-week run-in phase, during which they were converted to BUP TDS. Patients who could be stabilized on BUP TDS were randomized to BUP TDS or placebo patch for a two-week maintenance phase. Rescue medication (buprenorphine sublingual tablets 0.2 mg) was allowed as required. Response was defined as a mean pain intensity of <5 (0–10 scale) and a mean daily buprenorphine sublingual tablet intake of ≤2 tablets during the maintenance phase. Of 289 patients who entered the run-in phase, 100 discontinued treatment due to lack of efficacy or adverse events; 189 patients continued treatment in the maintenance phase (94 BUP TDS, 95 placebo), of whom 31 discontinued treatment (7 BUP TDS, 24 placebo). A significant difference in the number of treatment responders was observed: 70 BUP TDS (74.5%, 65.7–83.3) vs. 47 placebo (50%, 39.9–60.1) ( P = 0.0003). This result was supported by a lower daily pain intensity, lower intake of buprenorphine sublingual tablets and fewer dropouts in the BUP TDS group. The incidence of adverse events was slightly higher for BUP TDS. In conclusion, BUP TDS 70 μg/h is an efficacious and safe treatment for patients with severe cancer pain.

Transdermal buprenorphine in cancer pain and palliative care

Transdermal buprenorphine has been assessed as a therapy for chronic cancer and non-cancer pain in both clinical and postmarketing surveillance studies. Data from 239 patients who had participated in a follow-up study of up to six years have shown efficacy and safety, and good tolerability over prolonged treatment periods with a marked stability of doses. From the cancer pain population (134 patients), 20% stayed on transdermal buprenorphine until the end of their lives. Postmarketing surveillance study data from 13 179 patients, including 3690 cancer patients assessed during a 10-week observation period, showed that 81% of patients achieved good/very good pain relief with transdermal buprenorphine. Furthermore, 49.6% of patients did not require any analgesic comedication or rescue therapy, a point that is particularly important in the elderly population. Results from the Spanish Pain Society on transdermal buprenorphine in chronic non-cancer, neuropathic and cancer-related pain, and on switching from morphine, also confirmed its beneficial efficacy and safety, and showed that buprenorphine does not antagonize pain relief, or cause withdrawal when combined with full μ-agonists. The effectiveness of buprenorphine is further supported by evidence of its pronounced anti-hyperalgesic effect in a human pain model, which may be a factor in explaining the efficacy of buprenorphine in neuropathic pain. When switching of opioids is indicated to improve pain relief or reduce adverse events, equipotency dosage ratios are important. The equipotency ratio for morphine to buprenorphine, previously established as 75:1, is now being questioned as new data from a retrospective cohort study were published indicating a ratio of 100:1. Moreover, transdermal buprenorphine has superior safety in respect to respiratory depression, immunological and renal effects compared with standard World Health Organization step III opioids, which makes it highly suitable for treating moderate-to-severe pain also in cancer patients, a per se vulnerable patient population requiring a sensible selection of potent analgesics.

Buprenorphine in cancer pain: Its placing on analgesic ladder and possible association with NSAID

Buprenorphine in cancer pain: Its placing on analgesic ladder and possible association with NSAID

Buprenorphine in cancer pain. A cross-over comparison with pentazoctne

Buprenorphine in cancer pain. A cross-over comparison with pentazoctne

Protracted use of buprenorphine in cancer pain

(SPON: G. Broggi). Istit Wednesday Nazionale per la Ricerca sul Cancro. V.le Benedetto XV, 10.16132 Genova, Italy

A trial of sublingual buprenorphine in cancer pain.

1 Buprenorphine is a new antagonist analgesic which was offered sublingually to 141 patients with moderate cancer pain as an alternative to their current analgesic. These patients were not on regular strong morphine-like analgesics. 2 Forty-seven patients used the drug on demand in unit doses ranging from 0.15-0.8 mg for an average of 12 weeks. A full-time nurse-observer was used throughout the studies. 3 Good analgesic results were obtained. Certain difficult chronic dull aching pains in the head and neck were especially helped by the drug. There was no indication of dependence or tolerance in this study. 4 The main side-effect was drowsiness which lessened with usage of the drug. A major advantage of the drug was the absence of constipation as a side-effect. 5 This sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice.