Buprenorphine-Naloxone for Chronic Cancer-Related Pain in a Palliative Care Clinic

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY

Journal of pain and symptom management Pub Date : 2025-07-14 DOI:10.1016/j.jpainsymman.2025.07.006

Yoko Tarumi MD, PhD , Vickie Baracos PhD , Sonya Lowe MD, PhD , Ayoola Ademola PhD , Allison Chabassol MD , Tracy Wildeman MN, NP , Megan Sellick MD , Jennifer Dutka BSc, Pharm , Vincent Ha BSc, Pharm , Sharon M. Watanabe MD

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Abstract

Context

Long-term opioid therapy (LTOT) for chronic cancer-related pain can lead to negative consequences.

Objectives

To describe the use of buprenorphine, a pharmacologically unique opioid, combined with naloxone (Bup-Nal) for chronic cancer-related pain requiring LTOT.

Methods

Retrospective descriptive study conducted in a tertiary cancer center-based palliative care clinic. Routinely collected data were analyzed.

Results

A total of 47 persons with advanced cancer underwent switches to Bup-Nal from previous opioids. Mean/median ages were 56.2/56.5 years old. All were on disease-modifying treatment. Mean/median duration in months of previous opioid use prior to switch were 18.3 (standard deviation [SD]: 15.0)/14.0 (interquartile range [IQR]: 6.0–24.0). Mean/median oral morphine equivalent daily dose (MEDD) in mg prior to switch were 122.4 (SD: 98.8)/100.0 (IQR: 54.0–165.0). Mean/median total daily dose of buprenorphine in mg at stable pain control were 4.6 (SD: 4.9)/2.0 (IQR: 1.0–6.5). Mean/median dose conversion ratios for oral MEDD:sublingual buprenorphine were 39.4 (SD: 19.4)/35.8 (IQR: 26.6–50.0). Mean/median durations of Bup-Nal use in months were 6.7 (SD: 7.9)/4.0 (IQR: 2.0–8.0). Analysis of variance revealed that mean Edmonton Symptom Assessment System-Revised pain score diminished over time (chi-square: 36.0, P-value ≤0.001). Bup-Nal use >three months had greater pain score reduction over the 12-week observation period.

Conclusion

This retrospective descriptive study demonstrates that persons with advanced cancer and chronic cancer-related pain requiring LTOT could be successfully switched from other opioids to Bup-Nal, with a statistically significant decrease in pain over time, which was more pronounced in those on Bup-Nal for >three months. Prospective studies are warranted.

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丁丙诺啡-纳洛酮治疗姑息治疗诊所的慢性癌症相关疼痛。

背景：长期阿片类药物治疗慢性癌症相关疼痛可导致负面后果。目的：描述丁丙诺啡（一种药理学上独特的阿片类药物）与纳洛酮（Bup-Nal）联合治疗需要LTOT的慢性癌症相关疼痛的使用。方法：回顾性描述性研究在三级肿瘤中心为基础的姑息治疗诊所进行。分析常规收集的数据。结果：47名晚期癌症患者从先前的阿片类药物切换到Bup-Nal。平均/中位年龄为56.2/56.5岁。所有患者都接受了改善疾病的治疗。转换前阿片类药物使用月的平均/中位持续时间为18.3（标准差（SD）： 15.0）/14.0（四分位数间距（IQR）： 6.0-24.0）。切换前平均/中位口服吗啡当量日剂量（MEDD）（mg）为122.4 (SD: 98.8)/100.0 （IQR: 54.0-165.0）。丁丙诺啡在稳定疼痛控制时的平均/中位每日总剂量（mg）为4.6 (SD: 4.9)/2.0 （IQR: 1.0-6.5）。口服MEDD：舌下丁丙诺啡的平均/中位剂量转换比为39.4 (SD: 19.4)/35.8 （IQR: 26.6-50.0）。Bup-Nal使用月的平均/中位持续时间为6.7 (SD: 7.9)/4.0 （IQR: 2.0-8.0）。方差分析显示，平均ESAS-r疼痛评分随着时间的推移而降低（卡方：36.0，p值 = ），三个月的疼痛评分在12周的观察期中下降更大。结论：这项回顾性描述性研究表明，晚期癌症和慢性癌症相关疼痛需要LTOT的患者可以成功地从其他阿片类药物切换到Bup-Nal，随着时间的推移，疼痛有统计学意义上的显著减少，在Bup-Nal治疗50个月的患者中更为明显。前瞻性研究是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pain and symptom management 医学-临床神经学

CiteScore

8.90

自引率

6.40%

发文量

821

审稿时长

26 days

期刊介绍： The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.