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Area of Science:

  • Palliative Care
  • Addiction Medicine
  • Pharmacology

Background:

  • Increasing prevalence of patients with opioid use disorder (OUD) in palliative care.
  • Medication-assisted treatment (MAT) is common for OUD.
  • Buprenorphine, an FDA-approved MAT, presents unique challenges in palliative pain management.

Purpose of the Study:

  • To illustrate the management of co-occurring pain and OUD in a palliative care patient on buprenorphine.
  • To provide an overview of buprenorphine pharmacology and its implications in palliative care.
  • To discuss the unique aspects of the buprenorphine prescribing waiver and pain management strategies.

Main Methods:

  • Case study presentation.
  • Review of buprenorphine pharmacology.
  • Discussion of pain management principles in the context of buprenorphine therapy.

Main Results:

  • Buprenorphine can manage pain but complicates the use of full opioid agonists.
  • Effective management requires understanding buprenorphine's partial agonist properties.
  • A case example demonstrates managing OUD and pain across the illness trajectory.

Conclusions:

  • Integrated management of OUD and pain is crucial in palliative care.
  • Understanding buprenorphine's pharmacology is essential for safe and effective pain control.
  • Further strategies are needed to optimize care for palliative patients on buprenorphine.