Buprenorphine for Chronic Pain

Several formulations of buprenorphine are FDA-approved for the treatment of chronic pain in outpatient and inpatient settings, including delivery through a wearable skin patch or through the lining of the inner cheek, allowing the drug to enter the bloodstream directly.

Buprenorphine for Chronic Pain — Evidence Rating: Moderate Quality

Buprenorphine is an FDA-approved medication for the treatment of chronic pain that can be prescribed from a clinician’s office and filled at a pharmacy. Research data supporting the effectiveness of buprenorphine come from multiple randomized clinical trials and observational studies demonstrating that buprenorphine can reduce pain comparable to full agonist opioids, and offers a safer alternative to full agonist opioids with notably reduced likelihood of severe adverse events, including fatal overdose. While short-term analgesic efficacy is well documented, evidence for benefit beyond 16 weeks of treatment is lacking, as most trials do not extend past 16 weeks. Buprenorphine remains underutilized in the chronic pain management world largely due to a lack of comfort around prescribing and management practices for both care recipients and providers. Several considerations to bolster appropriate buprenorphine utilization for chronic pain are discussed in this evidence-based practice guide.

Evidence-based Scale

Buprenorphine is FDA-approved for chronic pain. It can be delivered either through a skin patch (brand named Butrans) or a dissolvable film (brand named Belbuca). The patch achieves more steady concentrations, avoiding peaks and troughs. The dissolvable film allows for quicker onset and more flexible dosing. Though no head-to-head studies exist comparing the two formulations of buprenorphine approved for chronic pain management, evidence suggests that the film is more effective in reducing pain, has fewer discontinuations, and has greater dosing flexibility. The dissolvable formulation provides a much wider range of dosing, particularly at the upper end, allowing greater flexibility in tailoring dosing to specific patient needs. A third buprenorphine formulation approved for pain is an intravenous formulation typically used in acute care settings.

There are several other buprenorphine formulations approved for the treatment of OUD. Various formulations of buprenorphine approved for the treatment of OUD have been used off-label to treat chronic pain.