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