Buprenorphine for intractable pain in bone marrow transplant recipients

Mayuko Sakae, MD, clinical assistant professor in the Department of Supportive Medicine at City of Hope, will discuss the results of a study on intractable pain in patients undergoing bone marrow transplants, presented at the 2024 Multinational Association for Supportive Care in Cancer Annual Meeting.

in the studyExperts investigated a new approach using buprenorphine compared with traditional opioids to manage severe pain during bone marrow transplantation.

Transcript:

0:09 | Our pilot prospective clinical trial was initiated after observing the severe pain associated with bone marrow transplantation experienced by patients with sickle cell disease. Their pain was uncontrolled despite the use of conventional multiple opioid analgesics in high doses and causing significant opioid side effects. Their pain remained uncontrolled even after trying all other pain management methods and techniques used when specialized supportive care consultation is sought for uncontrolled pain. It was only after introducing buprenorphine into the BMT pain management strategy for SCD patients in a pilot prospective clinical trial that things changed.

1:19 | The first key finding is that buprenorphine, an opioid analgesic with unique pharmacological properties, can provide effective pain management for patients suffering from uncontrolled pain with severe and complex pain histories, while significantly reducing opioid use. [adverse] That is, buprenorphine often produces less respiratory depression, gastrointestinal side effects such as constipation and nausea, and neurotransmissions that cause euphoria, cravings, depression, and stress compared to conventional full agonists.

2:05 | The second important point is that buprenorphine slows the development of opioid tolerance, meaning that buprenorphine can help patients who have a baseline hypersensitivity to pain avoid escalating opioid doses, which is not possible with traditional opioid analgesics such as morphine, oxycodone, or fentanyl. [Our study suggests that a timely collaboration with a supportive medicine specialty earlier in the process, before the pain level escalation, is beneficial].