The role of transdermal buprenorphine in the treatment of cancer pain: an expert panel consensus
Pergolizzi JV et al. - In an article to provide practical guidance on treatment of cancer pain with transdermal buprenorphine, particularly when there is a need for increasing pain relief leading to high and increasing doses, the consensus was that transdermal buprenorphine has a valuable role to play in treatment of chronic cancer pain because of its efficacy and good safety and tolerability profile, including a low risk of respiratory depression, lack of immunosuppression, and lack of accumulation in pts with impaired renal function. Methods- A literature search on the use of transdermal buprenorphine was carried out for the panel meeting and a number of case histories were presented and discussed.
- This commentary article presents this evidence and the consensus findings of the expert panel.
Results- The Panel reached consensus that transdermal buprenorphine was a valuable treatment for chronic cancer pain, including its neuropathic components.
- Large-scale, randomised clinical studies are needed to provide product comparisons on the use of analgesics in the treatment of neuropathic pain although it was recognised that such studies may not be practicable.
- Data on treatment of acute and chronic pain should be kept separate in general.
- Physicians should be made more aware of the problem of hyperalgesic effects of some opioids in long term use.
- Buprenorphine in contrast has been described to exert an antihyperalgesic effect.
- Development of analgesic tolerance with some opioids in long-term use and the lack of it with buprenorphine requires further studies.
- The registered dose range of 35–140 μg/h was considered adequate to achieve sufficient pain relief in most pts, although some members of the panel presented data showing that increases beyond this dose range provided improved pain relief if slow titration is used.
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