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Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option

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Abstract

The buprenorphine receptor binding profile is unique in that it binds to all three major opioid receptors (mu, kappa, delta), and also binds to the orphan-like receptor, the receptor for orphanin FQ/nociceptin, with lower affinity. Within the mu receptor group, buprenorphine analgesia in rodents is dependent on the recently discovered arylepoxamide receptor target in brain, which involves a truncated 6-transmembrane mu receptor gene protein, distinguishing itself from morphine and most other mu opioids. Although originally designed as an analgesic, buprenorphine has mainly been used for opioid maintenance therapy and only now is increasingly recognized as an effective analgesic with an improved therapeutic index relative to certain potent opioids. Albeit a second-, third-, or fourth-line analgesic, buprenorphine is a reasonable choice in certain clinical situations. Transdermal patches and buccal film formulations are now commercially available as analgesics. This review discusses buprenorphine pharmacodynamics and pharmacokinetics, use in certain populations, and provides a synopsis of systematic reviews and randomized analgesic trials. We briefly discuss postoperative management in patients receiving buprenorphine maintenance therapy, opioid equivalence to buprenorphine, rotations to buprenorphine from other opioids, and clinical relevance of buprenorphine-related QTc interval changes.

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Acknowledgements

This work was supported by grants from the National Institute on Drug Abuse (DA00641, DA007242), the Peter McManus Charitable Trust and The Mayday Fund to GWP and a core grant from the National Cancer Institute to MSKCC (CA008748).

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  1. Department of Palliative Care, Geisinger Medical Center, Danville, PA, USA

    Mellar P. Davis & Bertrand Behm

  2. Anne Burnett Tandy Chair in Neurology, Laboratory Head, Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Gavril Pasternak

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Davis, M.P., Pasternak, G. & Behm, B. Treating Chronic Pain: An Overview of Clinical Studies Centered on the Buprenorphine Option. Drugs 78, 1211–1228 (2018). https://doi.org/10.1007/s40265-018-0953-z

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