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Pain Management Strategies for Patients Receiving Extended-Release Buprenorphine for Opioid Use Disorder: A Scoping
Pouya Azar1,2, Jane J Kim1,2, Farbod Azarmju1
1Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada.
Substance Use : Research and Treatment
|June 18, 2025
Summary
Managing pain in patients with opioid use disorder (OUD) on extended-release buprenorphine (BUP-XR) is challenging. Current evidence suggests multimodal approaches, but high-quality guidelines are lacking.
Area of Science:
- Pharmacology
- Pain Management
- Addiction Medicine
Background:
- Pain management in patients with opioid use disorder (OUD) is complex.
- Extended-release buprenorphine (BUP-XR) is used for OUD treatment, but pain management strategies for these patients are not well-defined.
- Diverse and controversial management strategies exist for pain in OUD patients.
Purpose of the Study:
- To describe and evaluate pharmacologic pain management strategies for patients receiving BUP-XR for OUD.
- To synthesize current evidence on managing pain in patients treated with BUP-XR for OUD.
Main Methods:
- Scoping review of literature from multiple databases (Ovid Medline, EMBASE, CINAHL, Web of Science, PsycInfo) up to February 2025.
- Inclusion of articles discussing acute or chronic pain treatment in patients receiving BUP-XR.
- Extraction of data on pain severity, functioning, patient satisfaction, and adverse events; independent quality rating of studies.
Main Results:
- Only 6 articles met inclusion criteria from an initial search of 980, indicating poor overall evidence strength.
- Most studies utilized continuation of BUP-XR combined with other analgesics (opioids, non-opioids, NSAIDs) or conversion to sublingual buprenorphine.
- Adequate pain control was achieved in most cases without observed respiratory depression or toxicity.
Conclusions:
- Clear guidelines for pain management in BUP-XR treated patients are currently lacking.
- A multimodal analgesic approach combining opioids, non-opioid analgesics, and regional anesthesia is favored by clinicians.
- Further high-quality research, including randomized controlled trials, is necessary to establish optimal pain management strategies.
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