Buprenorphine in Dental Pain Management

Introduction to Buprenorphine Use

• The American College of Physicians suggests that buprenorphine should not be used as a first-line analgesic for dental pain, as the available evidence addresses its use primarily in chronic pain management, cancer pain, opioid use disorder, and perioperative analgesia, with a lack of specific guidelines for dental pain management 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

Special Considerations for Buprenorphine

• For patients on buprenorphine maintenance therapy who develop dental pain, the American Society of Addiction Medicine recommends continuing buprenorphine maintenance therapy and adding short-acting full opioid agonist analgesics, titrating to effect, with close monitoring for sedation and respiratory depression 6
• The American Pain Society suggests that dividing the daily buprenorphine dose into every 6-8 hour administration may leverage its analgesic properties for chronic pain, with doses of 4-16 mg daily divided into 8-hour doses showing benefit 1, 5, 6
• The National Institute on Drug Abuse advises against abruptly restarting buprenorphine in patients temporarily switched to full agonists, as precipitated withdrawal will occur, and against assuming buprenorphine has a ceiling effect for analgesia, as only respiratory depression has a documented ceiling 1, 2, 6