From the Guidelines
The incorrect statement regarding Buprenorphine is that it is a first-line opioid for treatment of chronic pain. Buprenorphine is actually not considered a first-line treatment for chronic pain; it is primarily used for opioid use disorder treatment and as a second or third-line option for pain management. Buprenorphine is a partial agonist at mu-opioid receptors (MOR) and an antagonist at kappa (KOR) and delta (DOR) opioid receptors, while also acting as an agonist at the ORL-1 receptor. According to the CDC guideline for prescribing opioids for chronic pain, nonopioid therapy is preferred for treatment of chronic pain, and opioids should be used only when benefits for pain and function are expected to outweigh risks 1. The guideline also states that opioids should not be considered first-line or routine therapy for subacute or chronic pain, and that expected benefits specific to the clinical context should be weighed against risks before initiating therapy 1.
Some key points to consider when using buprenorphine for pain management include:
- Buprenorphine has a high binding affinity for the μ-opioid receptor, which diminishes the ability of other more potent full agonist opioids to dislodge it from the receptor 1
- Buprenorphine is available as a sublingual tablet, sublingual film, and 6-month implant that are approved for the treatment of opioid use disorders; a transdermal patch is approved for the treatment of chronic pain 1
- The dose of buprenorphine can be increased to provide additional analgesia, but additional side effects may be more pronounced at higher doses 1
- For management of chronic pain in persons on buprenorphine for the treatment of opioid use disorder, clinicians might consider switching from buprenorphine/naloxone to buprenorphine transdermal alone 1
- Because buprenorphine does not occupy all opioid receptors, other opioids can be given when pain is acute, and high-potency opioids such as fentanyl or hydromorphone should be considered when the addition of nonpharmacologic treatments and nonopioid pharmacotherapies are ineffective 1.
Overall, while buprenorphine can be used for pain management, it is not a first-line treatment for chronic pain, and its use should be carefully considered and monitored to minimize risks and maximize benefits.
From the Research
Incorrect Statements about Buprenorphine
- There is no evidence in the provided studies to suggest an incorrect statement about Buprenorphine regarding its use in Opioid Use Disorder (OUD) and Chronic Pain management.
- All the studies 2, 3, 4, 5, 6 discuss the efficacy and safety of buprenorphine for chronic pain management and its potential as a treatment option for OUD.
Key Points about Buprenorphine
- Buprenorphine is a partial Mu Opioid Receptor (MOR) agonist and Kappa Opioid Receptor (KOR)/Delta Opioid Receptor (DOR) antagonist 5.
- It is approved by the US Food and Drug Administration (FDA) for acute pain, chronic pain, opioid use disorder (OUD), and opioid dependence 2.
- Buprenorphine offers superior patient tolerability, an excellent half-life, and minimal respiratory depression compared to most other opioids 2, 3, 5.
- It has a unique mechanism of action, allowing effective and long-lasting analgesia at microgram doses with fewer negative side effects and adverse events 4, 5.
Clinical Use of Buprenorphine
- Buprenorphine is considered a potentially safer alternative for medication management for patients who require chronic opioid therapy for pain or have OUD 2, 3, 4.
- The US Departments of Defense and Veterans Affairs, and the Department of Health and Human Services recommend buprenorphine as a first-line treatment for chronic pain managed by opioids 4.