Sublingual buprenorphine/naloxone for chronic pain in at-risk patients: Development and pilot test of a clinical protocol

摘要: Objective: Sublingual buprenorphine/naloxone (Bup/Nx) is approved for addiction treatment and may be useful pain management, particularly in opioid-treated patients with nonadherence behaviors. The transition of to buprenorphine carries the risk precipitated withdrawal increased pain. This study convened specialists develop pilot a clinical protocol safe transitioning Bup/Nx. Design: was revised three times based on outside expert review observations. conducted prospective cohort 12 moderate severe chronic pain, who were receiving long-term opioid therapy any full µ-agonist drug, had exhibited one or more aberrant drugrelated Patients followed up 3-6 months expectation that they would experience few adverse events (AEs) report lower severity. Results: highest baseline dose (equivalent 303-450 mg oral morphine) lowest doses (=20 mg) early AEs when switched Bup/Nx did not complete trial. Of remaining six, withdrew due AEs; responded well, then withdrew; four completed 3-month A mixed-effects model controlling dropouts found average worst significantly decreased after switch (both p < 0.01). Conclusion: Based this experience, recommends only are within bounds reduce at incorporates flexibility further risks. warrants testing. Keywords: buprenorphine, guidelines, therapy, DOI:10.5055/jom.2012.0137