Treating Chronic Pain with Buprenorphine
Pain -- both acute and chronic -- is an issue that affects a large number of the patients seen within primary care settings. Given the prevalence and the cost of pain to individuals, physicians who prescribe buprenorphine may find that they are approached by patients for its use in pain management.
A 7-day buprenorphine transdermal patch (BuTrans®) has been approved by the FDA for use in treatment of long term, moderate-to-severe chronic pain (Waknine 2010). Patches are available in 5, 10, and 20 μg/hour strengths (FDA 2010). Its use is contraindicated in the management of acute or short-term, postoperative, mild, and intermittent pain. It is not approved for treatment of opioid use disorder(Purdue Pharma 2010). Note that physicians do not need their DATA 2000 waiver in order to prescribe buprenorphine for pain.
Use of sublingual buprenorphine to treat pain is considered off-label. However, if a patient is already on buprenorphine for opioid treatment, dividing the buprenorphine dose can help address pain to some extent. Keep in mind that its analgesic property is around 8 hours.