Schmidt-Hansen, M., Bromham, N., Taubert, M., Arnold, S., & Hilgart, J.S. (2015). Buprenorphine for treating cancer pain. Cochrane Database of Systematic Reviews, 3, CD009596.

DOI Link

Purpose

STUDY PURPOSE: To assess the effects and tolerability of buprenorphine for cancer-related pain in adults and children

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Cochrane Collaboration, MEDLINE, EMBASE, ISI Web of Science, Clinical trials.gov, WHO international Clinical Trials Registry, and proceedings of the Congress of the European Federation of International Association for the Study of Pain
 
KEYWORDS: A full electronic search strategy was provided.
 
INCLUSION CRITERIA: Randomized, controlled trials with parallel groups or crossovers comparing buprenorphine to a placebo or an active drug; buprenorphine in any dose, formulation, or route of administration; adults and children with cancer-related pain
 
EXCLUSION CRITERIA: Studies of breakthrough pain

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 561
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane risk of bias assessment method was used. Overall quality of evidence was identified using the Grading of Recommendations Assessment, Development, and Evaluation approach. All studies included were deemed to be of low quality. The adequacy of titration also was evaluated, and patients appeared to be adequately titrated in only four studies. 

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 19 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,421
  • SAMPLE RANGE ACROSS STUDIES: 10–189 patients
  • KEY SAMPLE CHARACTERISTICS: Not provided

Phase of Care and Clinical Applications

APPLICATIONS: Palliative care

Results

Five studies looked at sublingual buprenorphine versus another formulation, tramadol (one), or pentazocine (two). Pain ratings did not differ significantly from those for tramadol. Buprenorphine was associated with better pain relief than pentazocine. Transdermal buprenorphine was compared to a placebo, controlled-release morphine, or transdermal fentanyl. Pain scores did not differ significantly from fentanyl and were lower in comparison to controlled-release morphine. Intramuscular, epidural, or IV buprenorphine was not substantially different in pain reduction compared to morphine given via the same routes.

Conclusions

Although buprenorphine evidence was limited and of low quality, the findings of this analysis suggested that buprenorphine was an effective pain reliever. The evidence was insufficient to suggest buprenorphine as a first-line treatment choice.

Limitations

  • Low quality studies
  • Very few studies with the same comparisons for evaluation
  • Very little evidence in children

Nursing Implications

Buprenorphine appeared to be an effective analgesic for cancer-related pain although the limited evidence for various formulations and comparisons suggested that it was not the most appropriate choice for first-line treatment. Buprenorphine may be useful in patients who receive opioid switching, or for whom alternatives to standard analgesic choices are needed.

Legacy ID

5593