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Buprenorphine Sees Lower Pain Scores Than Morphine
June 23, 2016 by Gary Culliton
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The effectiveness and tolerability of buprenorphine for treating cancer pain was discussed at the World Research Congress of the European Association of Palliative Care meeting in Dublin by Dr Mark Taubert, Consultant in Palliative Medicine and Clinical Lead for Palliative Care, Velindre Cancer Centre in Wales.

Dr Taubert discussed a Cochrane review (Schmidt-Hansen), on which he was a co-author, which assessed the effectiveness and tolerability of buprenorphine for cancer pain in adults and children.
For example, a person might present, having started on a buprenorphine transdermal patch, Dr Taubert said.

Buprenorphine is less constipating than morphine, studies have found (Bach 1991, Robbie 1979, PACE 2007). Buprenorphine had a long duration of action and it took time to leave the system, Dr Taubert said.
Cancer background pain was considered and — as in a number of previous Cochrane reviews — pain intensity was one primary outcome. Secondary outcomes included adverse effects. A total of 19 studies, published across 23 articles were considered, which had enrolled 1,421 patients.

In studies that considered transdermal buprenorphine, a clear dose–response relationship was not shown.

When transdermal buprenorphine was compared to controlled release morphine (PACE 2007), buprenorphine was associated with significantly lower pain scores.

Morphine patients had significantly higher rates of vertigo, constipation and nausea. However, there was no difference between the groups in terms of drowsiness, headaches and confusion.
Intramuscular bupren-orphine was found to have a similar analgesic effect compared to intramuscular morphine (Rigolot 1979).

Another study also showed similar maximum pain intensity outcomes, but buprenorphine side-effects (dizziness, nausea) were encountered (Kjaer 1982).

Transdermal buprenorphine and transdermal fentanyl showed similar outcomes (Sarhan 2009) in terms of mean pain scores, added Dr Taubert.



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