Pergolizzi JV Jr, Raffa RB Safety And Efficacy Of The Unique Opioid Buprenorphine For The Treatment Of Chronic Pain. J Pain Res. 2019 Dec 13;12:3299-3317. doi: 10.2147/JPR.S231948. eCollection 2019. (Systematic review)

Background: Chronic pain is associated with decreased quality of life and is one of the most common reasons adults seek medical care, making treatment imperative for many aspects of patient well-being. Chronic pain management typically involves the use of Schedule II full µ-opioid receptor agonists for pain relief; however, the increasing prevalence of opioid addiction is a national crisis that is impacting public health and social and economic welfare. Buprenorphine is a Schedule III partial µ-opioid receptor agonist that is an equally effective but potentially safer treatment option for chronic pain than full µ-opioid receptor agonists. The purpose of this review is to provide an overview of the clinical efficacy and safety of the transdermal and buccal formulations of buprenorphine, which are approved by the Food and Drug Administration for chronic pain, compared with that of extended-release full µ-opioid receptor agonists.

Methods: Controlled or randomized controlled clinical trial information was retrieved from EMBASE, Medline, and PubMed using the search terms "buprenorphine" AND "chronic" AND "pain."

Results: A total of 33 clinical studies were ultimately used in this review, including 29 (88%) on transdermal buprenorphine and 4 (12%) on buprenorphine buccal film. Although the measure of pain intensity varied among studies, each of these 33 trials demonstrated efficacy for buprenorphine in pain relief. A total of 28 studies also assessed safety, with each concluding that buprenorphine was generally well tolerated.

Conclusion: Comparison of current clinical data along with results of responder and safety analyses support the use of buprenorphine over full µ-opioid receptor agonists for effective preferential treatment of chronic pain; however, head-to-head clinical studies are warranted.

Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

Narcotics for control of chronic pain is an issue that is best left to pain specialists, if an underlying cause cannot be identified. Should the rest of us use narcotics? The claim that this particular one is safer is a claim we have heard before.

Physician rater

I don't need a systematic review with observational studies or comparison with a placebo. I need a systematic review of good clinical trials with best practices/active placebos.

Physician rater

This represents only preliminary data. We would need to know that long term outcomes (addiction, function etc) are different than with other oopioids.

Physician rater

This is vital information for primary care clinicians who treat chronic pain. I hope many will incorporate buprenorphine therapy into their clinical practice and prescribe fewer schedule II opioids.

Physician rater

This is a good information for an alternative to managing chronic pain in the elderly. Avoiding constipation and respiratory depression in older individuals with OA, chronic malignant/non-malignant pain is an important issue.
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