Pergolizzi, J.V., Jr., Mercadante, S., Echaburu, A.V., Van den Eynden, B., Fragoso, R.M., Mordarski, S., . . . Euromed Communications meeting. (2009). The role of transdermal buprenorphine in the treatment of cancer pain: An expert panel consensus. Current Medical Research and Opinion, 25(6), 1517–1528.

To provide practical guidance regarding the use of transdermal buprenorphine to treat cancer pain, particularly in those who need high-dose treatment to achieve pain control

• Of 122 articles retrieved, 22 were reviewed and made available to panel members before the November 2007 panel conference. Panel members contributed case reports for review. Authors provide points of discussion regarding several cases.
• Database searched was PubMed.
• Search keywords were buprenorphine, transdermal buprenorphine, neuropathic pain, and cancer pain.
• Attendance at the panel conference was funded by Grünenthal GmbH, the license holder of branded transdermal buprenorphine. The company paid the meeting chair's and primary author's honoraria. The primary author is a member of that company’s advisory board. Peer reviewers received honoraria from the parent organization of the company. The report states that the views expressed in the consensus statement are those of the expert panel and not necessarily those of the meeting sponsor.

The report provides information regarding the pharmacology and safety profile of transdermal buprenorphine. In addition, authors present some information, from studies and case reports, regarding efficacy. Authors provide no comprehensive review of search result or appraisal method. They do not detail the panel’s process.

• In identifying the benefits of transdermal buprenorphine in managing cancer pain, the panel concluded that the treatment
  • Is reliable and predictably efficacious.
  • Has antihyperalgesic potential.
  • Is effective, in low doses, at treating neuropathic pain. (Authors note effectiveness of transdermal buprenorphine compared to morphine.)
  • Has a favorable safety profile.
  • Presents a low risk of respiratory depression.
  • Is easy to use and convenient, involving a twice-weekly dosing schema.  
• The consensus was that transdermal buprenorphine
  • Is valuable in the treatment of cancer pain.
  • Is usable in combination with other opioids. (Authors note that no problems involving combination were reported.)
  • Offers advantages over other opioids in regard to treating neuropathic pain and mixed pain. 
• Authors identified the need for more research to determine best dosages and dose ceilings.

• The search was limited, as was the information the panel reviewed.
• Recommendations were created by consensus rather than based on standard appraisal of available evidence.
• A company that produces transdermal buprenorphine supported the work of the consensus group.

Expert opinion suggests that, for the treatment of cancer pain, transdermal buprenorphine is a useful alternative or adjunct to other medication.