Buprenorphine for Chronic Pain

Buprenorphine is a prescription opioid medication that is effective in treating two distinct conditions: 1) chronic pain, and 2) opioid use disorder (addiction). In some formulations, buprenorphine is FDA-approved for the treatment of moderate-to-severe chronic pain and is increasingly seen as a potentially safer option in chronic pain management compared to other commonly prescribed opioid medications.

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 a prescription opioid medication with formulations FDA-approved for the treatment of moderate-to-severe chronic pain. It is also approved for the treatment of opioid use disorder (OUD). Buprenorphine is a partial opioid receptor agonist. It binds to and activates opioid receptors in the body, producing pain-relieving effects. Research supports its use as a safe and effective medication for long-lasting pain management relative to full opioid receptor agonists such as codeine, hydrocodone, morphine and fentanyl. Buprenorphine is often considered a safer alternative to these full agonist opioids because increased dosing is not associated with increased respiratory depression, unlike other opioids. Buprenorphine has a reduced risk of misuse as it does not cause euphoria. In the early 2000s, Buprenorphine was FDA-approved for the treatment of OUD, and more recently, has been approved for pain management. It has increasingly been recognized in the pain management field as an effective medication for chronic pain management while carrying a lesser risk than full agonist opioids.