Transdermal
buprenorphine has been shown to be effective in managing moderate-to-severe
cancer pain and severe
pain that is unresponsive to
nonopioid analgesics. In clinical trials, it provided better
pain relief than placebo, despite a higher consumption of rescue
analgesia by placebo patients.
Analgesia was rated as satisfactory or better by 90% of patients in a long-term follow-up study and 94.6% considered the
buprenorphine matrix patch to be user friendly. Transdermal
buprenorphine is well tolerated; most adverse events are transient local reactions to the patch or systemic effects typical of treatment with
opioids. Even in
opioid-experienced volunteers,
buprenorphine does not cause
respiratory depression at doses up to 70-times higher than those used for
analgesia. No problems have been encountered when switching from another
opioid to transdermal
buprenorphine, or in combining the
buprenorphine patch with intravenous
morphine or
tramadol for
breakthrough pain. There is a growing body of evidence that transdermal
buprenorphine may be particularly useful for managing
neuropathic pain. Most notably, it appears to be effective in treating hyperalgesic states and syndromes characterized by pronounced central sensitization.