Buprenorphine for Refractory Pain in Patients Undergoing Bone Marrow Transplant

Mayuko Sakae, MD, City of Hope assistant clinical professor, Department of Supportive Care Medicine, discusses findings from her research presented at the 2024 Multinational Association of Supportive Care in Cancer Annual Meeting on refractory pain in patients who have undergone a bone marrow transplant.

In the study, experts investigated the use of buprenorphine as a novel approach to help manage severe pain compared with traditional opioids during bone marrow transplant.

Transcription:

0:09 | Our pilot prospective clinical trial was initiated after observing severe bone marrow transplant-related pain that our patients with sickle cell disease experienced. Their pain was uncontrolled even with the increasing use of multiple traditional opioid pain medications to high doses, which led to significant opioid side effects. Their pain was still uncontrollable by trying all the other pain management methods and techniques that we use when a specialty supportive medicine consult is requested for uncontrolled pain. This only changed when we introduced buprenorphine to the BMT pain management strategy for SCD patients in our pilot prospective clinical trial.

1:19 | The number 1 key finding is that buprenorphine, an opioid pain medication with unique pharmacological properties, can provide effective pain management in patients suffering from uncontrolled pain with severe and complex pain history with significantly less opioid [adverse] effects. This means buprenorphine often causes less respiratory depression, less gastrointestinal adverse effects such as constipation, nausea, less euphoria and craving, and less depressant- and stress-causing neurotransmission compared with traditional full agonists.

2:05 | Key point number 2 is that buprenorphine slows down the opioid tolerance development, meaning buprenorphine helps avoid further opioid dose-escalation, even in patients who have baseline hypersensitivity to pain. This would be an impossibility when we use traditional opioid pain medications like morphine, oxycodone, fentanyl, etc. [Our study suggests that a timely collaboration with a supportive medicine specialty earlier in the process, before the pain level escalation, is beneficial].