Buprenorphine for neuropathic pain--targeting hyperalgesia.
Opioids are well known to relieve severe, acute, and chronic nociceptive pain, but neuropathic pain shows a relatively poor response to opioids. Buprenorphine, a partial mu and ORL-1-receptor agonist, kappa-delta receptor antagonist, interacts with different G proteins than potent mu agonists and hence is not cross-tolerant to standard opioids. Buprenorphine blocks central sensitization (hyperalgesia) that is commonly found with neuropathic pain. We present a patient with neuropathic pain and tactile allodynia in which buprenorphine alleviated the hyperalgesia to a greater extent than pain severity. We found buprenorphine to be effective in reducing hypersensitivity in neuropathic pain when pure mu agonists fail to produce a response or in individuals who are intolerant to pure mu agonists.
Induru
Raghava R
RR
Division of Solid Tumor, Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio, USA.
Davis
Mellar P
MP
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy*; D008297:Male; D009437:Neuralgia / Q000188:drug therapy*; D051474:Neuralgia, Postherpetic / Q000188:drug therapy
D000701:Analgesics, Opioid; D002047:Buprenorphine