Pain

Long-acting, full-opioid agonists like methadone may be the best treatment option for opioid dependent patients with chronic pain, because they need pain relief 24 hours a day. There is a ceiling effect on buprenorphine's analgesic properties, and this medication may not provide adequate relief for chronic pain patients.

Note that buprenorphine is a highly effective analgesic when administered intramuscularly, but the sublingual administration of buprenorphine that is used when treating opioid dependence is significantly less potent and thus less effective in treating pain.

Related Resources: 
Description: 
This chapter provides information on using buprenorphine in patients who have special circumstances, including patients who have comorbid medical conditions or pain, pregnant patients, and adolescents.
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Patients who are suffering from acute pain can receive treatment for the pain while still taking buprenorphine. Note that buprenorphine itself is usually not sufficient for acute pain management because the duration of analgesia is relatively short. However, in some buprenorphine-maintained patients you can treat pain with buprenorphine (though this use is off-formulary) by increasing and dividing the daily dose and administering it every 6-8 hours (i.e.

Related Resources: 
Description: 
This brief article gives recommendations for treating buprenorphine patients who have acute pain.
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Ann Intern Med.
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This journal article (2006) discusses how to approach the treatment of acute pain in buprenorphine or methadone-maintained patients.
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Annals of Internal Medicine
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Description: 
This chapter provides information on using buprenorphine in patients who have special circumstances, including patients who have comorbid medical conditions or pain, pregnant patients, and adolescents.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Description: 
A Campaign to teach individuals and doctors about the risk of death by overdose common in chronic pain patients. Sponsored by Life Source.
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Zero Unintentional Deaths
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Description: 
The guideline provides recommendations for practice interventions and evaluations when using opioid therapy to treat chronic non-cancer pain. It is entirely evidence-based and uses clinical algorithms to optimize the use of opioid therapy.
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Department of Veterans Affairs; Department of Defense
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Guidelines from Boston Medical Center designed for patient maintained on buprenorphine underdoing invasive procedures.
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Colleen LaBelle, Boston Medical Center
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This medical news article talks about the FDA approval of Butrans and provides a summary of clinical study findings, drug administration, and warnings and adverse events.
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MedScape
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Description: 
This Medication Guide provides basic information about Butrans, the prescription medicine used for the management of moderate to severe chronic pain in patients requiring an around-the-clock opioid analgesic for a long period of time.
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Food and Drug Administration (FDA)
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Description: 
This article reviews the role of buprenorphine in treating patients with pain.
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Journal of Pain and Symptom Management
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Assessing Patients with Pain

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This page describes how to distinguish the needs of patients who have chronic pain from patients who are addicted to opioids.

Pain -- both acute and chronic -- is an issue that affects a large number of the patients seen within primary care settings. Given the prevalence and the cost of pain to individuals, physicians who prescribe buprenorphine may find that they are approached by patients seeking pain management.

However, while buprenorphine and other opioid agonists have been proven effective in treating chronic pain, there are a number of issues that complicate their implementation in pain management practice, including the following:

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