Many patients with
chronic pain have less than optimal therapeutic outcomes after prolonged treatment with
opiate analgesics. Worsening of pain perception, functional capacity, and mood often result. Medical detoxification is often undertaken in this situation. Ninety-five consecutive patients (49 men and 46 women; age range, 26-84) with chronic noncancer
pain (maldynia) were referred by local pain clinics for detoxification from long-term
opiate analgesic (LTOA)
therapy. All patients had failed treatment as manifest by increasing
pain levels, worsening functional capacity, and, in 8%, the emergence of
opiate addiction. Length of prior LTOA
therapy ranged from 1.5 to 27 years (mean, 8.8 years). After a minimum of 12 hours of abstinence from all
opiate analgesics, patients were given low doses of sublingual (SL)
buprenorphine or
buprenorphine/naloxone (Reckitt Benckiser). Maintenance dosing was individualized to treat
chronic pain. Daily SL dose of
buprenorphine ranged from 4 to 16 mg (mean, 8 mg) in divided doses. Mean
duration of treatment is 8.8 months (range, 2.4-16.6 months). At clinic appointments, patients were assessed for
pain reports, functional capacity, and mood inventory. Eighty-six percent of patients experienced moderate to substantial relief of
pain accompanied by both improved mood and functioning. Patient and family satisfaction was robust. Only 6 patients discontinued
therapy secondary to side effects and/or exacerbation of
pain. In this open-label study, SL
buprenorphine and
buprenorphine/naloxone were well tolerated and safe and appeared to be effective in the treatment of
chronic pain patients refractory to LTOA.