Buprenorphine--a review of its role in neuropathic pain

[Guest guest]

J Opioid Manag. 2007 Jul-Aug;3(4):195-206.

Buprenorphine--a review of its role in neuropathic pain.

Hans G.

Multidisciplinary Pain Center, Antwerp University Hospital, Edegem,

Belgium.

BACKGROUND: The use of opioids for the treatment of neuropathic pain

remains somewhat controversial, since earlier studies indicate that

neuropathic pain is generally less responsive to pure micro-opioid

analgesia. A growing body of evidence now suggests that different

opioids affect different pain pathways, and emerging data support

the possibility of a role for buprenorphine in the management of

neuropathic pain.

OBJECTIVE: This article reviews the preclinical and clinical data

for the role of buprenorphine in the treatment of neuropathic pain.

RESEARCH DESIGN AND METHODS: Literature searches were carried out

using PubMed (1988 to September 2006). Search terms included

buprenorphine and neuropathic pain, as well as neuropathy, painful

neuropathy, hyperalgesia, and allodynia. Clinical studies and case

studies were included.

RESULTS: Several assays, including the formalin, cold tail flick,

and diffuse noxious inhibitory control tests, have revealed

buprenorphine's potential efficacy in various pain types. These

findings seem to support hypotheses regarding its unique analgesic

mechanisms as compared with pure micro-opioids. The exact mechanism

of this analgesic efficacy remains unknown. Preclinical assessments

of buprenorphine demonstrate its sustained antihyperalgesic effect

in several models of neuropathic pain. These findings are supported

in clinical studies of oral, intrathecal, intravenous, and

transdermal buprenorphine. Furthermore, these studies have

demonstrated that, despite there being a ceiling effect for

respiratory depression, no relevant analgesic ceiling effect is

found with buprenorphine.

CONCLUSIONS: Further studies are certainly warranted to identify the

clinical neuropathic syndromes that are most sensitive to

buprenorphine treatment, and to compare buprenorphine with other

opioids in head-to-head trials of neuropathic pain.