[Buprenorphine and pain management: Clinical insights and practical landmarks]

Buprenorphine therapy is widely used in the treatment of opioid use disorder, and the use of its long-acting formulations is increasing. This raises concerns among healthcare professionals when analgesic management becomes necessary, due to its pharmacological properties. This article provides a synthesis of current pharmacological evidence and its implications for the management of acute and chronic pain, whether planned or unplanned. Practical landmarks are proposed according to the type of pain, the formulation used (buccal or subcutaneous), and the clinical context. Available data support the continuation of buprenorphine in most situations, including surgical settings, and suggest that a rational use of multimodal analgesia enables safe and effective pain management. Discontinuation of buprenorphine, long recommended to allow conventional analgesia with full opioid agonists, now appears to be a minority option, reserved for exceptional and anticipated cases. The management of patients receiving buprenorphine should not be viewed as a constraint, but rather as a pharmacological adaptation scenario grounded in well-established principles.