Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

• Published in: Journal of pain research Vol. 14; pp. 871 - 879
• Main Authors: Pergolizzi, Jr, Joseph V, Magnusson, Peter, LeQuang, Jo Ann, Breve, Frank, Mitchell, Kailyn, Chopra, Maninder, Varrassi, Giustino
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Acute pain; acute pain control; Analgesics; Buprenorphine; Care and treatment; ceiling effect of buprenorphine; Chronic pain; Drug dosages; geriatric pain patients; Gynecological surgery; hip arthroscopy; knee arthroscopy; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Morphine; Narcotics; opioid-associated side effects; orthopedic rehabilitation; Orthopedic surgery; Pain; Pancreatitis; Patient satisfaction; postoperative pain; Review; spinal surgery; Systematic review; transdermal buprenorphine dosing; Transdermal medication; transdermal buprenorphine dosing; postoperative pain; orthopedic surgery; opioid-associated side effects; ceiling effect of buprenorphine; gynecological surgery; spinal surgery; hip arthroscopy; knee arthroscopy; orthopedic rehabilitation; acute pain control; geriatric pain patients
• ISSN: 1178-7090; 1178-7090
• DOI: 10.2147/JPR.S280572

Transdermal buprenorphine is indicated for chronic pain management, but as its role in the clinical management of acute pain is less clear, this narrative review examines studies of the patch for acute pain, mainly in the postoperative setting. Although perhaps better known for its role in opioid rehabilitation programs, buprenorphine is also an effective analgesic that is a Schedule III controlled substance. Although buprenorphine is a partial agonist at the μ-opioid receptor, it is erroneous to think of the agent as a partial analgesic; it has full analgesic efficacy and unique attributes among opioids, such as a ceiling for respiratory depression and low "drug likeability" among those who take opioids for recreational purposes. Transdermal buprenorphine has been most thoroughly studied for acute pain control in postoperative patients. Postoperative pain follows a distinct and predictable trajectory depending on the type of surgery and patient characteristics. Overall, when the patch is applied prior to surgery and left in place for the prescribed seven days, it was associated with reduced postoperative pain, lower consumption of other analgesics, and patient satisfaction. Transdermal buprenorphine has been evaluated in clinical studies of patients undergoing gynecological surgery, hip fracture surgery, knee or hip arthroscopy/arthroplasty, shoulder surgery, and spinal surgery. Transdermal buprenorphine may also be appropriate pain medication for controlling pain during postsurgical orthopedic rehabilitation programs. Transdermal buprenorphine may result in typical opioid-associated side effects but with less frequency than other opioids. Despite clinical reservations about transdermal buprenorphine and its potential role in acute pain management in the clinical setting, clinical acceptance may be hampered by the fact that it is off-label and buprenorphine is better known as an opioid maintenance agent rather than an analgesic.