Buprenorphine Microinduction to Mitigate Withdrawal Symptoms During Abrupt Discontinuation of Intrathecal Fentanyl: A Case Report.

Background: Intrathecal pumps provide effective analgesia for many patients living with chronic pain. However, pump removal can present significant challenges from the pain management perspective, as patients are often highly opioid-tolerant and at significant risk of withdrawal. Buprenorphine microinduction has shown promise as a strategy for mitigating withdrawal symptoms while avoiding the respiratory depression associated with full agonist opioids. However, reports of its usage in patients undergoing intrathecal pump removal are limited.

Case report: We present the case of a 56-year-old woman with chronic non-cancer back pain who was successfully transitioned to oral buprenorphine using a microinduction protocol when her longstanding intrathecal pump was abruptly discontinued.

Conclusions: This case demonstrates that buprenorphine microinduction may be a safe and effective method of mitigating opioid withdrawal symptoms in non-cancer pain patients undergoing abrupt intrathecal pump discontinuation.