High Dose Transdermal Buprenorphine for Pain

Permalink: http://doctordeluca.com/wordpress/archive/transderm-bup-4-pain/

Journal article referenced:
Carlos Barutell, Alberto Camba, José-Ramón González-Escalada, Manuel Rodríguez (2008). ‘High Dose Transdermal Buprenorphine for Moderate to Severe Pain in Spanish Pain Centres-A Retrospective Multicenter Safety and Efficacy Study’
Pain Practice, 8 (5), 355-361, 2008.
DOI: 10.1111/j.1533-2500.2008.00205.x

See also:
TD Buprenorphine for Everything and Everyone
D. Rosielle, Pallimed; 2008-07-17 (Note also the Comments)

Clinical Update on… Transdermal Buprenorphine
H. Kress; European Journal of Pain, 2008.

Brief Comment (Abstract below)

Transdermal buprenorphine isn’t even available in the US, though I believe it has become the most widely used opioid for the treatment of chronic moderate-to-severe pain in Europe.

In the US buprenorphine has become associated with the outpatient treatment of heroin and other opioid abuse, which seems to have caused pharmacists and physicians nationwide to have become ‘struck stupid,’ regarding everything to do with this medication, and confusion reigns regarding the labeling of the sublingual (Subutex) versus the labeling for the identical molecule in ampule form (Buprenex), and about what licensing and regulator rules apply to what physicians depending on the purpose for which it is being prescribed.

What a mess! And an interesting example of the distortion of medical and pharmacy practice by drug war imperatives applied against the professions through misguided laws and regs. For a discussion of some of these issues, I recommend a blog essay and ensuing Comments, also linked to above, “TD Buprenorphine for Everything and Everyone” – by Dr. Drew Rosielle of the Pallimed blog, July 2008, which presents and discusses another recent, very large, European review of buprenorphine for chronic pain, entitled: Clinical Update on the Pharmacology, Efficacy and Safety of Transdermal Buprenorphine – H. Kress; European Journal of Pain, 2008.


High Dose Transdermal Buprenorphine for Moderate to Severe Pain in Spanish Pain Centres—A Retrospective Multicenter Safety and Efficacy Study
Barutell et. al; Pain Practice; 8(5): 355-361; 2008

Obectives: To assess the effectiveness of transdermal buprenorphine in patients suffering from moderate to severe pain. Secondary objectives included gathering information about the causes of pain, management of episodic pain, and the safety profile.

Methods: Retrospective data were collected from 1,465 patients with moderate to severe pain, ie, ?50 mm on a 0 to 100 mm visual analog scale (VAS), that were switched to transdermal buprenorphine, and received a dose ?52.5 ?g/hour for at least 14 days during the previous 12 months. Pain could have any etiology. Most patients (72.1%) were on tramadol and/or paracetamol (40.7%) before switching to buprenorphine. Using case report forms, efficacy was determined from changes in VAS score compared with 24 hours prior to the first patch application. Safety was evaluated by retrieving information about the nature and incidence of adverse events (AE), whether they were related to the study compound, and the percentage considered being serious.

Results: An absolute reduction of 25.1 points in VAS score was seen over a median period of 3.7 months treatment. In addition, the VAS score was reduced by at least 10% in 88.4% of patients and the incidence of episodic pain fell significantly. Treatment was rated as “Good” or “Very Good” by 82.5% of patients. Out of 1,465 patients, 50.2% experienced an AE; this was related to the drug in 48.8%, and considered serious in 4.0%.

Conclusions: Transdermal buprenorphine was an effective and considerably safe drug for relieving chronic moderate to severe pain.



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