Management of Chronic Pain with Buprenorphine and Pregabalin
Introduction to Buprenorphine and Pregabalin
- The American College of Physicians recommends maintaining therapy with buprenorphine and adding appropriate adjuvant therapies for the type of pain, for patients with chronic pain on buprenorphine 1, 2
- Buprenorphine transdermal is an effective option for the treatment of chronic pain, with continuous release of the medication 3
- Due to buprenorphine's high affinity for the μ-opioid receptor, abrupt interruption can lead to withdrawal symptoms and poor pain control 3, 4
Role of Adjuvant Therapies
- Adjuvant therapies like pregabalin can allow for better pain control with lower doses of opioids 1, 2
- Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) such as sertralina (50-200mg/day) are well-tolerated and have minimal effects on the metabolism of other medications 5
- Mirtazapina (7.5-30mg at bedtime) is potent, well-tolerated, and may be beneficial in patients with sleep and appetite problems 5
Considerations for Antidepressant Use
- The selection of an antidepressant should consider prior treatment response, tolerance, and potential side effects 5
- Patients with depression and chronic pain should be regularly evaluated for treatment response and adverse effects 2, 6
- Screening for depression is recommended for all patients with chronic pain 6