Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series
Background Buprenorphine may provide superior analgesia to full opioid agonist therapy and reverse the effects of opioid-induced hyperalgesia, while having a favorable safety profile and fewer adverse effects, in chronic non-cancer pain treatment. Low-dose initiation of buprenorphine is a useful str...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Canadian Journal of Pain |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/24740527.2024.2310811 |
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| author | Maya Rattanavong Donica Kwan Derek Jorgenson Eric Landry Radhika Marwah Katelyn Halpape |
| author_facet | Maya Rattanavong Donica Kwan Derek Jorgenson Eric Landry Radhika Marwah Katelyn Halpape |
| author_sort | Maya Rattanavong |
| collection | DOAJ |
| description | Background Buprenorphine may provide superior analgesia to full opioid agonist therapy and reverse the effects of opioid-induced hyperalgesia, while having a favorable safety profile and fewer adverse effects, in chronic non-cancer pain treatment. Low-dose initiation of buprenorphine is a useful strategy for patients on long-term opioid therapy because it avoids the need for moderate opioid withdrawal required for traditional buprenorphine initiations. However, there are few published reports of low-dose initiation regimens in the setting of chronic pain.Aims The aim of the study was to describe a case series of individuals living with chronic pain who were transitioned from long-term full opioid agonist therapy onto sublingual buprenorphine/naloxone using low-dose initiation regimens.Methods This study is a retrospective case series that included all patients who received care at an outpatient chronic pain clinic and were scheduled for low-dose initiation of buprenorphine/naloxone between March 2020 and December 2022. Data were collected through a retrospective review of electronic medical records and results were analyzed using descriptive statistics.Results Eighteen patients underwent transitions from their baseline opioids onto buprenorphine/naloxone using a low-dose initiation regimen. Of those patients, 17 successfully completed the initiation (94.44%), 12 experienced adverse effects during the initiation (66.67%), with only one patient requiring treatment discontinuation, and all adverse effects resolved once maintenance doses of buprenorphine/naloxone were established. The mean Clinical Global Impression–Improvement score after initiation was 2 (1–5).Conclusion Low-dose initiation is an effective approach to transition patients with chronic non-cancer pain from long-term opioid therapy to buprenorphine/naloxone without major complications or worsening pain. |
| format | Article |
| id | doaj-art-e746f1a49c7f44eda954c3926671f320 |
| institution | Kabale University |
| issn | 2474-0527 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Canadian Journal of Pain |
| spelling | doaj-art-e746f1a49c7f44eda954c3926671f3202024-12-16T20:54:59ZengTaylor & Francis GroupCanadian Journal of Pain2474-05272024-12-018110.1080/24740527.2024.2310811Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case SeriesMaya Rattanavong0Donica Kwan1Derek Jorgenson2Eric Landry3Radhika Marwah4Katelyn Halpape5College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaFamily Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCollege of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaBackground Buprenorphine may provide superior analgesia to full opioid agonist therapy and reverse the effects of opioid-induced hyperalgesia, while having a favorable safety profile and fewer adverse effects, in chronic non-cancer pain treatment. Low-dose initiation of buprenorphine is a useful strategy for patients on long-term opioid therapy because it avoids the need for moderate opioid withdrawal required for traditional buprenorphine initiations. However, there are few published reports of low-dose initiation regimens in the setting of chronic pain.Aims The aim of the study was to describe a case series of individuals living with chronic pain who were transitioned from long-term full opioid agonist therapy onto sublingual buprenorphine/naloxone using low-dose initiation regimens.Methods This study is a retrospective case series that included all patients who received care at an outpatient chronic pain clinic and were scheduled for low-dose initiation of buprenorphine/naloxone between March 2020 and December 2022. Data were collected through a retrospective review of electronic medical records and results were analyzed using descriptive statistics.Results Eighteen patients underwent transitions from their baseline opioids onto buprenorphine/naloxone using a low-dose initiation regimen. Of those patients, 17 successfully completed the initiation (94.44%), 12 experienced adverse effects during the initiation (66.67%), with only one patient requiring treatment discontinuation, and all adverse effects resolved once maintenance doses of buprenorphine/naloxone were established. The mean Clinical Global Impression–Improvement score after initiation was 2 (1–5).Conclusion Low-dose initiation is an effective approach to transition patients with chronic non-cancer pain from long-term opioid therapy to buprenorphine/naloxone without major complications or worsening pain.https://www.tandfonline.com/doi/10.1080/24740527.2024.2310811Buprenorphine/naloxonemicrodosingmicro-inductionlow-dose inductionlow-dose initiationBernese method |
| spellingShingle | Maya Rattanavong Donica Kwan Derek Jorgenson Eric Landry Radhika Marwah Katelyn Halpape Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series Canadian Journal of Pain Buprenorphine/naloxone microdosing micro-induction low-dose induction low-dose initiation Bernese method |
| title | Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series |
| title_full | Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series |
| title_fullStr | Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series |
| title_full_unstemmed | Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series |
| title_short | Low-dose Initiation of Buprenorphine/naloxone for the Management of Chronic Non-cancer Pain in Patients on Long-term Opioid Therapy: A Case Series |
| title_sort | low dose initiation of buprenorphine naloxone for the management of chronic non cancer pain in patients on long term opioid therapy a case series |
| topic | Buprenorphine/naloxone microdosing micro-induction low-dose induction low-dose initiation Bernese method |
| url | https://www.tandfonline.com/doi/10.1080/24740527.2024.2310811 |
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