Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain.
Buprenorphine is an opioid that has a complex and unique pharmacology which provides some advantages over other potent mu agonists. We review 12 reasons for considering buprenorphine as a frontline analgesic for moderate to severe pain: (1) Buprenorphine is effective in cancer pain; (2) buprenorphine is effective in treating neuropathic pain; (3) buprenorphine treats a broader array of pain phenotypes than do certain potent mu agonists, is associated with less analgesic tolerance, and can be combined with other mu agonists; (4) buprenorphine produces less constipation than do certain other potent mu agonists, and does not adversely affect the sphincter of Oddi; (5) buprenorphine has a ceiling effect on respiratory depression but not analgesia; (6) buprenorphine causes less cognitive impairment than do certain other opioids; (7) buprenorphine is not immunosuppressive like morphine and fentanyl; (8) buprenorphine does not adversely affect the hypothalamic-pituitary-adrenal axis or cause hypogonadism; (9) buprenorphine does not significantly prolong the QTc interval, and is associated with less sudden death than is methadone; (10) buprenorphine is a safe and effective analgesic for the elderly; (11) buprenorphine is one of the safest opioids to use in patients in renal failure and those on dialysis; and (12) withdrawal symptoms are milder and drug dependence is less with buprenorphine. In light of evidence for efficacy, safety, versatility, and cost, buprenorphine should be considered as a first-line analgesic.
Cleveland Clinic Lerner School of Medicine at Case Western University, OH 44195, USA. davism6@ccf.org
Mellar P
MP
Davis
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004361:Drug Tolerance; D005853:Geriatrics; D006801:Humans; D009369:Neoplasms / Q000150:complications; D009437:Neuralgia / Q000188:drug therapy; D009293:Opioid-Related Disorders / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017450:Receptors, Opioid, mu / Q000187:drug effects; D051437:Renal Insufficiency / Q000378:metabolism
D000701:Analgesics, Opioid; D017450:Receptors, Opioid, mu; D002047:Buprenorphine