Patients who have Chronic Pain

Long-acting, full-opioid agonists like methadone may be the best treatment option for opioid dependent patients with chronic pain, because they need pain relief 24 hours a day. There is a ceiling effect on buprenorphine's analgesic properties, and this medication may not provide adequate relief for chronic pain patients.

Note that buprenorphine is a highly effective analgesic when administered intramuscularly, but the sublingual administration of buprenorphine that is used when treating opioid dependence is significantly less potent and thus less effective in treating pain.

Follow these clinical guidelines when treating chronic pain in patients who are maintained on buprenorphine:

  • First try to determine the cause of the pain and if is related to the opioid dependence (i.e. perhaps the patient is experiencing the discomfort of withdrawal symptoms and a greater dose of buprenorphine is needed).
  • Try to manage the patient's pain with non-opioid and adjuvant analgesics as well as non-pharmacologic therapies.
  • Consult a more experienced buprenorphine provider or pain medicine or other specialist (i.e. chiropractor, osteopath, physical therapist) as appropriate to manage localized symptoms.
  • Be aware of the high risk of relapse among opioid dependent patients who are experiencing chronic pain.
  • Consider transfer to methadone maintenance with additional opioid analgesics to manage intractable pain.


Related Resources: 
Pain Management: Patients Maintained on Buprenorphine
Description: 
Presentation discussing the treatment of acute and chronic pain in buprenorphine-maintained patients.
Source: 
Integrated Substance Abuse Program, UCLA
4
Your rating: None Average: 4 (3 votes)
Tags:
TIP 40 Chapter 5: Special Populations
Description: 
This chapter provides information on using buprenorphine in patients who have special circumstances, including patients who have comorbid medical conditions or pain, pregnant patients, and adolescents.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
4.666665
Your rating: None Average: 4.7 (3 votes)
Tags: