Buprenoprine, a medication that has been successfully used in patients who are fighting opioid addictions may also be an effective analgesic when used in the sublingual form.
A semisynthetic opioid, buprenorphine has a wider safety profile compared with other full opioid agonists. There also appear to be fewer issues with withdrawal when treatment with buprenorphine is discontinued.
Although the medication has an effect that can last for more than 24 hours when being used as treatment for opioid addiction, for pain relief, studies show that buprenorphine works best at three or four times a day dosages, sublingually.
Physicians who wish to prescribe buprenorphine as a treatment for opioid dependence, in the United States, may prescribe it with or without naloxone, but the physician must be a certified or specially trained physician who has received a waiver fro the requirement to register as a narcotic treatment program from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. However, off-label use of buprenorphine (Suboxone/Subutex) does not have the same requirements of the prescribing physicians. In order to prevent confusion with the pharmacy, however, it is best if the physician writes Chronic pain patient, or off-label use, in order to clarify the prescription.
When treating a patient with opioid addiction and who has pain, the approach will change according to the type of pain. The groups of pain are: anticipated acute pain (such as impending surgery), unanticipated acute pain (trauma), acute pain superimposed on chronic pain, and chronic pain.
When treating the pain, one issue is if the patient is NPO, fasting, as buprenorphine may not be a viable option, and other medications, such as oral transmucosal fentanyl lozenge, may be considered. For chronic pain, both with superimposition of acute pain or chronic pain alone, the divided doses of buprenorphine should be titrated to effect and in cases of acute pain, assisted with an immediate release/rapid-onset opioid.
The authors of this article point out that buprenorphine can be used effectively to treat patients how have pain as well as the disease of opioid addiction. By understanding the pharmacokinetics of buprenorphine, it is possible to prescribe the appropriate medications in the appropriate doses for this group of patients.
Howard A. Heit, MD, FACP, FASAM, an Douglas L. Gourlay, MD, MSc, FRCPC, FASAM. Buprenorophine; New Tricks with an Old Molecule for Pain Management. In The Clinical Journal of Pain. February 2008. Vol. 24. No. 2.'