Not Just for Addiction: The Palliative Clinician's Guide to Using Buprenorphine for Pain
Buprenorphine is widely used as a treatment for patients with opioid use disorders, but has also been shown to be an effective treatment for cancer and neuropathic pain, with unique pharmacologic properties that give it several advantages over traditional opioids. Buprenorphine is associated with less analgesic tolerance, and is less likely to cause respiratory depression and constipation than other opioids. Buprenorphine also does not cause immunosuppression, sphincter of Oddi dysfunction, or hypogonadism like traditional opioids. It may be ideal to consider for elderly or frail patients, because it causes less cognitive dysfunction and sedation. In addition, patients are less likely to experience severe withdrawal symptoms and develop drug dependence on buprenorphine when compared with other opioids.
Because of these advantages, some have proposed that buprenorphine should be considered as a first line treatment for patients requiring an opioid medication. In this concurrent session, we will review the pharmacology, indications and concerns for monitoring when using buprenorphine. We will discuss the practical uses of buprenorphine in patients who are opioid-naïve and opioid-tolerant. We will present cases outlining equianalgesic conversions, differences between the transdermal patch, sublingual tab and buccal formulations, as well as use in special populations, including the elderly/frail and patients with renal or hepatic impairment. The teaching format will be a mixture of large group didactic and interactive case-based presentations.
Upon completion of this activity the learner should be better able to:
- Explain the basic pharmacology of buprenorphine
- Discuss the rationale for using buprenorphine as a frontline analgesic for pain
- Identify common concerns and troubleshooting the use of buprenorphine in clinical practice
- Illustrate the successful use of buprenorphine for the treatment of a variety of pain conditions with patient cases demonstrating equianalgesic conversions
- Describe the practical methods used to obtain outpatient approval for buprenorphine from insurance companies and hospital formularies
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All editors, faculty and staff have disclosed no relevant financial relationships.
*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. (Exclusions at the time of this writing included 501-C not-for-profit organizations, government organizations, liability and health insurance providers, non-healthcare-related companies, group medical practices, for-profit healthcare providers, blood banks and diagnostic laboratories.)
Amy Case, MD FAAHPM
Sidra Anwar, MD
Eric Hansen, MD
Justin Kullgren, PharmD
Sandra Pedraza, MD FAAFP
Mellar Davis, MD FCCP FAAHPM
Continuing Medical Education (CME)
The American Academy of Hospice and Palliative Medicine (AAHPM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Academy of Hospice and Palliative Medicine (AAHPM) designates this Enduring material for a maximum of 0.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME credits expire October 13, 2024.
Maintenance of Certification (MOC)
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit."
ABIM MOC points expire on October 13, 2024.
Physicians certified with the American Board of Internal Medicine who wish to earn MOC points within the current calendar year must submit their MOC data no later than December 31 of the calendar year.
- 0.50 ABIM MOC
- 0.50 CME (physician only)
- 0.50 Participation