Buprenorphine for Long-Term Chronic Pain Management: Still Looking for the Evidence
Authors: Roger Chou, Jane Ballantyne, Anna Lembke
Journal: Annals of Internal Medicine (2020)

Letters18 February 2020Buprenorphine for Long-Term Chronic Pain Management: Still Looking for the EvidenceRoger Chou, MD, Jane Ballantyne, MD, and Anna Lembke, MDRoger Chou, MDOregon Health & Science University, Portland, Oregon (R.C.)Search for more papers by this author, Jane Ballantyne, MDUniversity of Washington School of Medicine, Seattle, Washington (J.B.)Search for more papers by this author, and Anna Lembke, MDStanford University School of Medicine, Stanford, California (A.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0684 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Schatman and colleagues contend that it is premature to suggest buprenorphine as a substitute for full opioid agonists in patients with chronic pain and opioid dependence because of a lack of long-term data on effectiveness. Yet, the evidence on long-term effectiveness of pure opioid agonists is also lacking, with few placebo-controlled trials longer than 16 weeks (1). The risks for serious harms associated with pure opioid agonists are well documented. Most important, our article focuses on patients who meet criteria for persistent opioid dependence, a condition on the opioid use disorder continuum. Such patients have exhibited difficulty ...References1. Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: A systematic review and meta-analysis. JAMA. 2018;320:2448-2460. [PMID: 30561481] doi:10.1001/jama.2018.18472 CrossrefMedlineGoogle Scholar2. Martin SA, Chiodo LM, Bosse JD, et al. The next stage of buprenorphine care for opioid use disorder. Ann Intern Med. 2018;169:628-635. [PMID: 30357262]. doi:10.7326/M18-1652 LinkGoogle Scholar3. Aiyer R, Gulati A, Gungor S, et al. Treatment of chronic pain with various buprenorphine formulations: A systematic review of clinical studies. Anesth Analg. 2018;127:529-538. [PMID: 29239947] doi:10.1213/ANE.0000000000002718 CrossrefMedlineGoogle Scholar4. Cote J, Montgomery L. Sublingual buprenorphine as an analgesic in chronic pain: a systematic review. Pain Med. 2014;15:1171-8. [PMID: 24995716] doi:10.1111/pme.12386 CrossrefMedlineGoogle Scholar5. Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Anesthesiology. 2014;120:1262-74. [PMID: 24509068] doi:10.1097/ALN.0000000000000170 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Oregon Health & Science University, Portland, Oregon (R.C.)University of Washington School of Medicine, Seattle, Washington (J.B.)Stanford University School of Medicine, Stanford, California (A.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1488. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRethinking Opioid Dose Tapering, Prescription Opioid Dependence, and Indications for Buprenorphine Roger Chou , Jane Ballantyne , and Anna Lembke Buprenorphine for Long-Term Chronic Pain Management: Still Looking for the Evidence Michael E. Schatman , Hannah Shapiro , and David J. DiBenedetto Metrics 18 February 2020Volume 172, Issue 4Page: 294KeywordsAnalgesicsDisclosureFood and Drug AdministrationOpioid use disorderOpioidsPain managementPopulation statisticsSafety ePublished: 18 February 2020 Issue Published: 18 February 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...