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

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

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

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

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.

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.