JAMA Sub-Journal: What is the risk of changing to buprenorphine for long-term opioid patients?

As we all know, opioids, as the main type of analgesia, are very effective in relieving moderate to severe pain
.

However, long-term use of opioid therapy (LTOT) will bring health risks, including opioid abuse, suppression of immune and endocrine functions, disorders of self-reward and punishment mechanisms, and neurohormonal defects

As we all know, opioids, as the main type of analgesia, are very effective in relieving moderate to severe pain

Recently, a study published in the journal JAMA JAMANetw Open showed that buprenorphine is related to the reduction of chronic pain without causing opioid withdrawal or other serious adverse reactions

In this study, the researchers searched through PubMed , CINAHL , Embase, and PsycInfo for original English-language peer-reviewed studies by criminal officials that reported the pre-determined results of chronic pain patients shifting from long-term opioid prescriptions to buprenorphine , And evaluate the quality of the research
.

In this study, the researchers searched through PubMed , CINAHL , Embase, and PsycInfo for original English-language peer-reviewed studies by criminal officials that reported the pre-determined results of chronic pain patients shifting from long-term opioid prescriptions to buprenorphine , And evaluate the quality of the research
.

The researchers analyzed a total of 22 studies, of which 5 were randomized clinical trials, 7 were case-control or cohort studies, and 10 were uncontrolled studies, involving a total of 1616 participants, including 675 womenand 941 men
.

Six of the 22 studies are primary or secondary analyses of large randomized clinical trials .

The researchers analyzed a total of 22 studies, of which 5 were randomized clinical trials, 7 were case-control or cohort studies, and 10 were uncontrolled studies, involving a total of 1616 participants, including 675 women and 941 men

It was found that the reasons for buprenorphine rotation include inadequate analgesia, intolerable adverse reactions, and risks of opioid treatment regimens (for example, high-dose and buprenorphine rotation reasons include inadequate analgesia, adverse reactions Intolerance, risk of opioid treatment regimens (for example, high-dose and / or sedative co-prescription) and abnormal use of opioids

Very low-quality evidence suggests that buprenorphine rotation is related to the maintenance or improvement of analgesia, and the risk of inducing opioid withdrawal is very low
.

Stable doses of buprenorphine are better tolerated than decreasing doses of buprenorphine

Very low-quality evidence suggests that buprenorphine rotation is related to the maintenance or improvement of analgesia, and the risk of inducing opioid withdrawal is very low

At the same time, adverse reactions are controllable, and serious adverse events are rare

In short, although these findings are synthesized from low-quality to very low-quality studies, they show that the buprenorphine rotation is alleviating.
Although these findings are synthesized from low-quality to very low-quality studies, It shows that buprenorphine rotation is a feasible strategy to reduce the harm of LTOT .
Future research needs to address the best starting dose, formulation and frequency of buprenorphine, and the best method of buprenorphine rotation .

Original source

Victoria D.

Powell, MD ^1,2 ;Jack M.
Rosenberg, MD ^3,4,5,6 ;Avani Yaganti, BS ⁷ ;et al.

Victoria D.
Powell, MD ^1,2 ;Jack M.
Rosenberg, MD ^3,4,5,6 ;Avani Yaganti, BS ⁷ ;^{1,2 1,2} Jack M.
Rosenberg, MD ^{3,4,5,6 3 ,4,5,6} Avani Yaganti, BS ^{7 7} et al.
Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain A Systematic Review .
Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain A Systematic Review JAMA Netw Open.
2021;4(9):e2124152.
doi:10.
1001/jamanetworkopen.
2021.
24152 JAMA Netw Open.
 

 

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