Transdermal Buprenorphine for Central Neuropathic Pain: Clinical Reports

Guetti, Cristiana; Angeletti, Chiara; Marinangeli, Franco; Ciccozzi, Alessandra; Baldascino, Giada; Paladini, Antonella; Varrassi, Giustino

doi:10.1111/j.1533-2500.2010.00434.x

Cited by 16 publications

(10 citation statements)

References 41 publications

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“…Because of buprenorphine's clinical efficacy as an analgesic for acute (Johnson et al, 2005) and neuropathic (Hans, 2007;Pergolizzi et al, 2009;Pergolizzi et al, 2010;Vadivelu and Anwar, 2010;Guetti et al, 2011) pain and the known analgesic doses used in rodents (Kouya et al, 2002;Christoph et al, 2005) and humans (Yassen et al, 2006), phMRI of this particular opioid was an ideal test case in which the translatability of a phMRI readout could be elucidated. For human studies specifically, the doses evaluated did not yield any reported subjective feelings by healthy volunteers to the drug versus placebo during the scanning session, thus enabling a double-blinded, cross-over (drug versus placebo) study paradigm to be performed.…”

Section: Discussionmentioning

confidence: 99%

Parallel Buprenorphine phMRI Responses in Conscious Rodents and Healthy Human Subjects

Becerra

Upadhyay

Chang

et al. 2013

The Journal of Pharmacology and Experimental Therapeutics

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Pharmacological magnetic resonance imaging (phMRI) is one method by which a drug's pharmacodynamic effects in the brain can be assessed. Although phMRI has been frequently used in preclinical and clinical settings, the extent to which a phMRI signature for a compound translates between rodents and humans has not been systematically examined. In the current investigation, we aimed to build on recent clinical work in which the functional response to 0.1 and 0.2 mg/70 kg i.v. buprenorphine (partial m-opioid receptor agonist) was measured in healthy humans. Here, we measured the phMRI response to 0.04 and 0.1 mg/kg i.v. buprenorphine in conscious, naive rats to establish the parallelism of the phMRI signature of buprenorphine across species. PhMRI of 0.04 and 0.1 mg/kg i.v. buprenorphine yielded dose-dependent activation in a brain network composed of the somatosensory cortex, cingulate, insula, striatum, thalamus, periaqueductal gray, and cerebellum. Similar dose-dependent phMRI activation was observed in the human phMRI studies. These observations indicate an overall preservation of pharmacodynamic responses to buprenorphine between conscious, naive rodents and healthy human subjects, particularly in brain regions implicated in pain and analgesia. This investigation further demonstrates the usefulness of phMRI as a translational tool in neuroscience research that can provide mechanistic insight and guide dose selection in drug development.

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Section: Discussionmentioning

confidence: 99%

Parallel Buprenorphine phMRI Responses in Conscious Rodents and Healthy Human Subjects

Becerra

Upadhyay

Chang

et al. 2013

The Journal of Pharmacology and Experimental Therapeutics

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“…Buprenorphine, unlike the pure m-opioid agonist fentanyl, has demonstrated a significant long-lasting antihyperalgesic action in a human pain model where hyperalgesia was induced by central sensitization (16). A small, but growing body of clinical evidence supports the potential of buprenorphine in neuropathic pain (10), including case series (17,18), a retrospective observational study in patients with refractory neuropathic pain (19), and a postmarketing surveillance study (20). To date, no placebocontrolled trials have assessed transdermal buprenorphine in neuropathic pain or specifically DPNP.…”

mentioning

confidence: 99%

Transdermal Buprenorphine Relieves Neuropathic Pain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial in Diabetic Peripheral Neuropathic Pain

Simpson

Wlodarczyk

2016

Diabetes Care

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OBJECTIVETo evaluate the efficacy and safety of transdermal buprenorphine in patients with diabetic peripheral neuropathic pain (DPNP). RESEARCH DESIGN AND METHODSThis multicenter, randomized, double-blind, placebo-controlled, parallel-group trial enrolled patients with type 1 or type 2 diabetes and stable glycemic control who had been experiencing moderate to severe DPNP for at least 6 months on maximal tolerated conventional therapy. Patients were randomly assigned to receive buprenorphine (5 mg/h) or placebo patches. The dose was titrated to effect to a maximum of 40 mg/h. Paracetamol was available as rescue analgesia. The severity of pain and other symptoms of DPNP were assessed daily in a patient diary and at clinic visits. RESULTSOne hundred eight-six patients were enrolled, with 93 randomized to either buprenorphine or placebo. A high proportion of patients did not complete the study (buprenorphine 37 of 93, placebo 24 of 93). The main reason for premature withdrawal in the buprenorphine group was adverse events commonly due to untreated nausea and/or vomiting. Among the per-protocol population, more patients in the buprenorphine group (86.3%) experienced a 30% reduction in average versus baseline pain at week 12 than those in the placebo group (56.6%, P < 0.001). A nonsignificant trend favored the buprenorphine group within the intention-to-treat analysis of the same end point (51.7% vs. 41.3%, P = 0.175). CONCLUSIONSTransdermal buprenorphine, when tolerated, is an effective therapy for DPNP and provides another option to manage this challenging painful condition. Nausea and constipation need to be managed proactively to optimize treatment outcomes.

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“…Moreover, clonidine, as an a2-adrenoceptor agonist, can be used in neuropathic pain [35], as well as ketamine [35]. Transdermal buprenorphine has also been used successfully for central neuropathic pain [36]. Palmitoylethanolamide (PEA) has been recommended for chronic neuropathic pain, as well [15,16].…”

Section: Treatment Planmentioning

confidence: 99%

“…Fluvoxamine and mexiletine may be used adjunctively in some patients [53]. Transdermal buprenorphine may also be useful in some cases [36].…”

Section: Treatment Planmentioning

confidence: 99%

Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review

et al. 2020

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Pain management is challenging for both clinicians and patients. In fact, pain patients are frequently undertreated or even completely untreated. Optimal treatment is based on targeting the underlying mechanisms of pain and tailoring the management modality for each patient using a personalized approach. This narrative review deals with pain conditions that have a complex underlying mechanism and need an individualized and frequently multifactorial approach to pain management. The research is based on previously conducted studies, and does not contain any studies with human participants or animals performed by any of the authors. This is not an exhaustive review of the current evidence. However, it provides the clinician with a perspective on pain therapy targeting the underlying pain mechanism(s). When dealing with complex pain conditions, the prudent physician benefits from having a deep knowledge of various underlying pain mechanisms in order to provide a plan for optimal pharmacological pain relief to patients.

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Transdermal Buprenorphine for Central Neuropathic Pain: Clinical Reports

Cited by 16 publications

References 41 publications

Parallel Buprenorphine phMRI Responses in Conscious Rodents and Healthy Human Subjects

Parallel Buprenorphine phMRI Responses in Conscious Rodents and Healthy Human Subjects

Transdermal Buprenorphine Relieves Neuropathic Pain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial in Diabetic Peripheral Neuropathic Pain

Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review

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