Buprenorphine vs Opioids: No Added Pain Relief or Opioid Dose Reduction

This study examined whether giving patients with chronic pain the option to switch from high-dose, long-term opioid therapy to buprenorphine would improve pain management and reduce opioid use. The researchers wanted to see if this approach would lead to better pain relief and lower opioid doses compared to not offering the switch.

Many patients with chronic pain rely on high-dose opioids, which can cause dependence and withdrawal symptoms. Reducing opioid use is crucial to avoid these risks. Buprenorphine, a safer alternative, might help. This research is important for healthcare providers and patients seeking effective pain management strategies with less reliance on high-dose opioids.

The researchers conducted a 12-month randomized clinical trial at Veterans Affairs clinics, involving 207 participants with chronic pain on high-dose opioids. Participants were split into two groups: one had the option to switch to buprenorphine, and the other did not have the option to switch. Pain levels and opioid doses were measured at the start and end of the study.

Both groups experienced small improvements in pain scores and substantial reductions in opioid doses over 12 months. Offering the option to switch to buprenorphine did not result in greater improvements in pain or further reductions in opioid use compared to not offering the option. Only 26% of participants in the buprenorphine option group switched.

Providing the option to switch to buprenorphine did not lead to significant differences in pain relief or opioid reduction compared with not offering the option. However, some patients may still benefit from switching, for example, those who have already tried a standard taper and did not succeed, underscoring the importance of personalized care and multiple treatment options. This study emphasizes the need for effective strategies to manage opioid dependence in chronic pain treatment.

The authors suggest that future research should focus on promoting a more prominent discussion of buprenorphine within whole-person pain care plans to better evaluate its potential as an alternative treatment to high-dose, long-term opioid therapy.

In the study, the mean Brief Pain Inventory score improved from 6.8 to 6.1 in the buprenorphine option group (adjusted mean difference [AMD], −0.59; 95% CI, −0.89 to −0.29) and from 6.8 to 6.3 in the no option group (AMD, −0.50; 95% CI, −0.81 to 0.20). The opioid dosage decreased from 157 mg/d to 94 mg/d in the buprenorphine group (AMD, −61.0 mg/d; 95% CI, −74.1 to −47.9) and from 165 mg/d to 107 mg/d in the no option group (AMD, −58.5 mg/d; 95% CI, −71.6 to −45.4).

This research was supported by the Patient-Centered Outcomes Research Institute (contract OPD-1511-33052), by Yale University, and by resources and the use of facilities from the US Department of Veterans Affairs.