Facilitating discontinuation of intravenous opioids by concurrent use of sublingual buprenorphine with rapid microdosing induction: A pain management case study

Abstract

We report a case in which sublingual buprenorphine was used to help transition a patient off intravenous (IV) opioid analgesics medications post-multiple abdominal procedures. Intravenous opioids are commonly used in inpatient surgical pain management for patients with severe pain who are unable to take oral medications. Typically, a short course of IV analgesics is used, followed by transition to oral analgesic regimen. However, in patients with poor gastrointestinal absorption, pain control can be challenging. We present this case to highlight how sublingual buprenorphine can be a useful agent for acute pain management, especially when conventional strategies provide suboptimal responses.

Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series

“…One patient resumed full opioid agonist therapy due to inadequate pain control Crum et al 24 Case report 76-year-old female with CNCP and an intrathecal hydromorphone-bupivacaine pump (daily OME inconsistent) Transition from intrathecal hydromorphone-bupivicaine to bup/nal (8 mg bup/day divided BID) using a low-dose initiation regimen in an inpatient hospital setting Successful transition to bup/nal while providing adequate pain control and preventing withdrawal and ventilatory depression. Patient self-discontinued bup/nal without use of other opioids Lee et al 25 Case report 66-year-old female with inadequately controlled postoperative pain Transition from oxycodone and methadone to bup/nal (12 mg bup/day) using a rapid low-dose initiation regimen in an inpatient postoperative setting Successful transition to bup/nal with no significant withdrawal symptoms and improved pain, function, and mood Tara et al 26 Case report 27-year-old female unable to tolerate PO intake with uncontrolled acute on chronic pain taking opioid analgesics Transition from full opioid agonist to bup/nal (8 mg bup/day) using a low-dose initiation regimen in an inpatient hospital setting Successful transition to bup/nal with improved pain relief. Patient elected to taper off bup/nal prior to discharge Leyde et al 19 Case report 22-year-old female with sickle cell disease and CNCP taking oxycodone (daily OME 960 mg) Transition from oxycodone to bup/nal (40 mg bup/day in four divided doses) using low-dose buprenorphine transdermal patch as a bridge in an inpatient hospital setting Successful transition to bup/nal with minimal withdrawal symptoms and improved functioning MacAusland-Berg et al 27 ,c Case report 80-year-old female with inadequately controlled chronic pain Transition from intranasal butorphanol to bup/nal (4 mg bup/day divided BID) using a low-dose initiation regimen in an outpatient interdisciplinary chronic pain clinic Successful transition to bup/nal with minimal withdrawal symptoms and no pain exacerbations a Excludes OME calculation of one patient due to unreliable conversion.…”