Is Buprenorphine Effective for Chronic Pain? A Systematic Review and Meta-analysis

Lazaridou, Asimina; Paschali, Myrella; Edwards, Robert R.; Gilligan, Christopher

doi:10.1093/pm/pnaa089

Cited by 27 publications

(26 citation statements)

References 43 publications

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“…However, it should be noted that there is evidence to suggest that buprenorphine is relatively ineffective at reducing pain intensity in patients with comorbid opioid use disorder. 36 Given that pain appears to be the driver for aberrant behaviours in this group, these patients may find non-pharmacological interventions – such as physical therapy and training in self-management strategies – to be more effective in managing their pain while reducing the risk of exacerbating their OD. It is difficult to comment in detail on the appropriateness of methadone treatment for the ODD→CP group, and future studies should consider comparing functional outcomes in this group with those of ODD patients with no pain.…”

Section: Discussionmentioning

confidence: 99%

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

Higgins

Smith

Matthews

2021

British Journal of Pain

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Background: Chronic pain is highly prevalent in treatment-seeking opioid-dependent patients; therefore, this comorbid presentation is an important clinical consideration for both addiction and pain specialists. The objectives of the present study were to examine whether the direction of causal attribution of opioid dependence disorder and chronic pain resulted in two distinct clinical populations, and, if so, to compare treatment received during the 5-year follow-up period. Methods: Participants comprised opioid-dependent patients with chronic pain who reported a perceived causal relationship, in either direction, between the development of these two conditions ( n = 252). A range of health- and addiction-related instruments were used at study inception. Treatment characteristics were obtained for the follow-up period from national health registers. Results: Those reporting that pain caused opioid dependence disorder ( n = 174; 69%) were characterised by poorer pain-related health, more illicit cannabinoid use ( p = 0.031), more frequent illicit use of opioid analgesics ( p = 0.025) and they were in receipt of higher doses of prescribed opioid analgesics. Those reporting that opioid dependence disorder caused pain ( n = 78; 31%) were characterised by poorer overall physical health ( p = 0.002), more severe psychiatric symptoms and more overall drug use ( p = 0.001). Conclusion: Two distinct clinical populations were identified, determined by how participants perceive the causal relationship between opioid dependence disorder and chronic pain. These two populations have differing clinical profiles and treatment requirements: those reporting that pain caused opioid dependence disorder were characterised by poorer pain-related health and more illicit use of drugs with analgesic properties; and those reporting that opioid dependence disorder caused pain were characterised by more overall use of substances, multiple substance use and more intravenous substance use and poorer general health. Identifying the causal direction, where such a relationship exists, could help addiction and pain services to develop more effective, individualised treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

Higgins

Smith

Matthews

2021

British Journal of Pain

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“…49,51,[59][60][61] In a meta-analysis examining the effects of buprenorphine (SL, transdermal, and buccal) on chronic pain outcomes in patients with or without opioid use disorder (OUD), the authors found that efficacy was more pronounced in patients without OUD, and high doses may be needed for patients with OUD. 62 Overall, the data from these studies suggest that buprenorphine has equivalent or greater clinical analgesic efficacy than conventional opioids.…”

Section: Benefit-risk Assessment Of Buprenorphine Vs Conventional Opioids Efficacymentioning

confidence: 93%

Benefit-Risk Analysis of Buprenorphine for Pain Management

Hale

Garofoli²,

Raffa³

2021

JPR

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Health care providers in the United States are facing challenges in selecting appropriate medication for patients with acute and chronic pain in the midst of the current opioid crisis and COVID-19 pandemic. When compared with conventional opioids, the partial µ-opioid receptor agonist buprenorphine has unique pharmacologic properties that may be more desirable for pain management. The formulations of buprenorphine approved by the US Food and Drug Administration for pain management include intravenous injection, transdermal patch, and buccal film. A comparison of efficacy and safety data from studies of buprenorphine and conventional opioids suggests that buprenorphine may be a better-tolerated treatment option for many patients that provides similar or superior analgesia. Our benefit-risk assessment in this narrative review suggests that health care providers should consider that buprenorphine may be an appropriate alternative for pain management over other opioids.

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“…Those with chronic pain also benefit less from MOUD in comparison to those without chronic pain, suggesting there may be additional treatment needs (Ilgen et al, 2006). Finally, MOUD appears to have limited analgesic effects in those with OUD and chronic pain (Lazaridou et al, 2020). Therefore, MOUD alone may be insufficient for the management of co-occurring OUD and chronic pain.…”

mentioning

confidence: 99%

“…It was also hypothesized that a majority of the sample would transition between the high and low pain interference profiles over the course of treatment, given that BUP/NX and the study treatment have been shown to promote opioid abstinence and lifestyle changes leading to improved quality of life (Volkow et al, 2019; Weiss et al, 2011). Further, the pain intensity profiles would remain stable over the course of treatment, given that BUP/NX has a limited effect on pain intensity (Lazaridou et al, 2020) and the study treatment involved only one session of pain coping skills.…”

mentioning

confidence: 99%

Changes in pain during buprenorphine maintenance treatment among patients with opioid use disorder and chronic pain.

Edwards¹,

Vowles²,

McHugh³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: Opioid use disorder (OUD) and chronic pain frequently co-occur. Little is known about changes in pain during buprenorphine/naloxone (BUP/NX) maintenance and whether outcomes vary by pain levels. The current study examined changes in pain intensity and pain interference over 12 weeks of BUP/NX maintenance among participants with OUD and chronic pain (N=194). Differences in outcomes were assessed during BUP/NX maintenance (week 12) and two months following a BUP/NX taper (week 24). Method: Data from Phase 2 of the Prescription Opioid Addiction Treatment Study were used. Two latent transition models were conducted to characterize profiles and transitions between profiles of pain intensity or pain interference (estimated separately). Results: Each model identified a high and low profile. In the pain interference model, the majority were classified in the low profile at baseline. In the pain intensity model, the majority were classified in the high profile at baseline. In both models, patients were more likely to remain in or transition to the low profiles by week 12. Worse depression was associated with membership in the high pain interference profile at both timepoints. Women were more likely to be in the high pain intensity profile at baseline. Those in the high pain intensity and high pain interference profiles at week 12 reported worse mental health quality of life at week 12, as well as high pain intensity and high pain interference at week 24. Conclusions: For a subgroup of patients, high pain intensity and high pain interference remains unchanged during BUP/NX maintenance treatment.

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Is Buprenorphine Effective for Chronic Pain? A Systematic Review and Meta-analysis

Cited by 27 publications

References 43 publications

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

Opioid dependence disorder and comorbid chronic pain: comparison of groups based on patient-attributed direction of the causal relationship between the two conditions

Benefit-Risk Analysis of Buprenorphine for Pain Management

Changes in pain during buprenorphine maintenance treatment among patients with opioid use disorder and chronic pain.

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