Naing, C., Aung, K., Racloz, V., & Yeoh, P.N. (2013). Safety and efficacy of transdermal buprenorphine for the relief of cancer pain. Journal of Cancer Research and Clinical Oncology, 139, 1963–1970.
STUDY PURPOSE: To determine the efficacy and safety of transdermal buprenorphine for treating cancer pain
TYPE OF STUDY: Meta-analysis a systematic review
DATABASES USED: MEDLINE, EMBASE, CINAHL, and the Cochrane Library up to May 2013
KEYWORDS: Search terms for the cancer type, including gastrointestinal, bladder, breast, stomach, colon, prostate, and lung; search term for buprenorphine
INCLUSION CRITERIA: Patients with cancer; RCTs; comparison of transdermal buprenorphine to placebo or any comparator drug; changes in cancer pain intensity measured by verbal rating scales, visual analog scales, numerical rating scales, or questionnaires
EXCLUSION CRITERIA: Sample size of less than 10 patients; pain that was not directly linked to the development of cancer or its treatment (i.e., chemotherapy-induced neuropathic pain); pain related to surgical procedures
TOTAL REFERENCES RETRIEVED = 212
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The quality of the studies was assessed by two reviewers using the domain-based evaluation.
Two studies of patients whose pain relief was at least satisfactory at all time points found a significant difference between transdermal buprenorphine and placebo in all three doses of transdermal buprenorphine, 35.5, 52.5, or 70 micrograms per hour (RR 1.74, 95% Cl 1.31–2.32; I2 0%). Pain-free sleep was improved in two studies comparing transdermal buprenorphine to placebo (RR 1.25, 95% Cl 0.84–1.88; I2 0%). Adverse effects such as nausea, vomiting, and constipation were less with transdermal buprenorphine compared to fentanyl, morphine, or placebo.
Transdermal buprenorphine appears to be an effective and safe treatment for cancer pain; however, further research is needed to confirm its effectiveness because of the low quality of published research. Information about the following research quality indicators was unclear for a majority of the studies.
Although transdermal buprenorphine has been shown to have advantages over other opioids (i.e., noninvasive route, reduced respiratory depression, less frequent adverse effects), further research is needed to confirm its level of effectiveness in relieving cancer pain. In addition, the long-term effects of transdermal buprenorphine need to be determined. If nurses are caring for patients who are prescribed transdermal buprenorphine, they should be aware of the potential adverse effects, which are similar to other opioids.