What is the efficacy of buprenorphine in managing panic attacks and pain?

From the Guidelines

Buprenorphine is not typically recommended as a first-line treatment for panic attacks, but it is effective for managing chronic pain, and its use should be considered on a case-by-case basis, taking into account the patient's medical history and current medications, as suggested by the most recent study in 2021 1. When considering the use of buprenorphine for pain management, it is essential to note that it is a partial opioid agonist, providing pain relief with a lower risk of respiratory depression and dependence compared to full opioid agonists. The medication is available in various formulations, including sublingual tablets (2-24 mg daily), transdermal patches (5-20 mcg/hour changed weekly), or injectable forms. However, buprenorphine can cause side effects, including nausea, constipation, headache, and dizziness, as reported in a study published in 2017 1. Some key points to consider when using buprenorphine for pain management include:

• The medication has a ceiling effect for respiratory depression, making it safer in overdose situations than full opioid agonists, as noted in a study published in 2019 1.
• Buprenorphine may pose a greater challenge than methadone in achieving analgesia during acute episodes of pain, but its dose can be increased to provide additional analgesia, as suggested by a study published in 2017 1.
• For patients on buprenorphine maintenance treatment for opioid use disorder who have inadequate pain control, consideration should be given to adding or replacing it with an additional long-acting potent opioid, such as fentanyl, morphine, or hydromorphone, as recommended in a study published in 2021 1. In terms of managing panic attacks, medications like selective serotonin reuptake inhibitors (SSRIs) such as sertraline (50-200 mg daily) or escitalopram (10-20 mg daily), or benzodiazepines like alprazolam (0.25-0.5 mg as needed) are more commonly prescribed. If a patient is experiencing both chronic pain and panic attacks, it would be better to address these conditions separately with targeted medications rather than relying solely on buprenorphine, as this approach allows for more effective management of each condition and minimizes the risk of adverse interactions or side effects, as implied by the studies 1.

From the Research

Efficacy of Buprenorphine in Managing Pain

• Buprenorphine has been shown to be an effective analgesic agent in both adult and pediatric surgical patients, as well as in treating chronic pain, particularly in cancer pain and neuropathic pain 2.
• A systematic review of clinical studies demonstrated that buprenorphine is a pharmacologic agent that can be used for the treatment of various types of painful conditions, with transdermal buprenorphine formulation being an effective analgesic in patients with chronic pain 3.
• Buprenorphine offers a safer alternative for patients who require opioids to manage chronic pain, given its unique pharmacological properties that allow it to provide adequate analgesia with less abuse potential 4.
• It has been recommended to consider buprenorphine as a first-line opioid for chronic pain, especially in the elderly, as it may be associated with less cognitive impairment, falls, sexual dysfunction, and sarcopenia when compared with schedule II opioids 5.

Efficacy of Buprenorphine in Managing Panic Attacks

• There is no direct evidence in the provided studies to support the efficacy of buprenorphine in managing panic attacks.
• However, buprenorphine may be useful in patients with comorbid substance use disorder or non-medical opioid use, as there is less risk of misuse, euphoria, and it may improve mood 5.

Buprenorphine Initiation Strategies

• Novel initiation strategies suggest that concomitant administration of small doses of buprenorphine with opioids can avoid the unwanted withdrawal associated with buprenorphine initiation 6.
• A systematic review of buprenorphine initiation strategies found that traditional initiation and microdosing initiation were effective for patients with opioid use disorder, pain, or both, with 95.6% and 96% of patients successfully rotating to sublingual buprenorphine, respectively 6.