A narrative review of buprenorphine in adult cancer pain

ABSTRACT

Introduction

Adult cancer pain is a disease state battled on a global scale. Proper pain management is essential to prevent health complications and promote patient well-being. Due to the opioid misuse crisis in the United States, providers are looking for alternatives to traditional opioids used for adult cancer pain. Buprenorphine has a unique pharmacologic profile, allowing it to be delivered in noninvasive ways; thus, it offers an alternative to traditional options. Randomized controlled trials have shown improved pain scores with transdermal buprenorphine, and they showed reductions in pain scores and increased improvement in quality of life scores versus other opioids. Sublingual buprenorphine has more limited, but promising data for reducing cancer pain.

Areas covered

We provide a narrative review of pathophysiological pathways of pain in cancer, how they are treated, and the unique properties of buprenorphine. Guidelines addressing pain management during cancer treatment are assessed to identify buprenorphine’s place in therapy. Recent literature reporting efficacy and safety of buprenorphine use in pain management during cancer treatment will be presented.

Expert opinion

Current literature shows strong data for transdermal buprenorphine and promising data for sublingual buprenorphine. With this evidence, buprenorphine could have a more expanded role in managing adult cancer pain.

KEYWORDS:

• Buprenorphine
• cancer pain
• combination drug buprenorphine with naloxone
• opioids
• quality of life
• transdermal formulation of buprenorphine

Article highlights

• Because of the current opioid crisis, there is a need for effective and safer analgesics for cancer pain.

• Buprenorphine has multiple mechanism of interactions with opioid receptors mu, kappa, and opioid receptor-like 1.

• Buprenorphine is a potent analgesic through multiple modes of delivery with potential tolerability and safety advantages compared with morphine.

• Metabolic and elimination properties of buprenorphine allow for use in patients with renal or hepatic impairment and with concomitant medications.

• Buprenorphine has high potential for expanded use in treatment of adult cancer pain at the proper dose.

Acknowledgments

The editorial review and constructive criticism of Dr. Kelly A. Keating (Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences) is greatly appreciated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.