Resource Recommended by Dr. Brianna McQuade: Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion

In this article, an expert panel convened to address common misconceptions surrounding buprenorphine and provide clinical recommendations on its appropriate use for chronic pain management. Buprenorphine, a Schedule III partial µ-opioid receptor agonist, offers unique pharmacokinetic (PK) and pharmacodynamic (PD) parameters that make it a viable and safe alternative to chronic opioids for pain.

The panel reviewed relevant literature and discussed key aspects of buprenorphine use. They emphasized that while buprenorphine is classified as a partial µ-opioid receptor agonist, this should not be interpreted to imply partial analgesic efficacy. Instead, buprenorphine was recommended before some Schedule II, III, or IV opioids for patients with a favorable risk/benefit profile, considering factors such as metabolic considerations, abuse potential, and tolerability. The panel advised continuing buprenorphine during the perioperative period, highlighting its efficacy and safety in these scenarios. Additionally, when converting patients from a full µ-opioid receptor agonist to buprenorphine, the panel suggested starting doses based on the previous opioid dose, without the need for a weaning period.

These recommendations provide clinicians with a comprehensive framework to navigate various clinical scenarios related to buprenorphine use in chronic pain management. Overall, the consensus of the panel underscores buprenorphine's unique pharmacologic properties and safety profile, making it a valuable option for addressing the complex needs of patients with chronic pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139205/