Buprenorphine for chronic pain in a pediatric patient with sickle-cell disease
pediatric; palliative care; pain; buprenorphine; sickle-cell disease
Sickle-cell disease (SCD) is an inherited hematologic disorder characterized by the presence of sickle-shaped red blood cells (RBC). 1 Misshapen RBCs are rigid, which leads to occlusion of blood vessels resulting in tissue ischemia and pain. Pain can manifest as acute, intermittent episodes (vaso-occlusive crises [VOC]), chronic pain, or acute-on-chronic pain. 1 Buprenorphine is a semisynthetic opioid that has historically been used for opioid use disorder. Due to a unique receptor binding profile and favorable safety profile, including lower risk of tolerance and hyperalgesia, buprenorphine is increasingly recognized for its utility in chronic pain management, especially in complex cases. 2 ,3 Two small studies reported decreased healthcare utilization and daily opioid requirements in adults with chronic SCD pain transitioned from full opioid agonists to buprenorphine. 4 ,5 Another case series of two adolescents with chronic SCD pain described rotation to buprenorphine with improved functionality and decreased opioid requirements. 6 Literature on buprenorphine for pain in pediatric patients is sparse in general and practically nonexistent for pediatric chronic SCD pain. 7 Here, we report buprenorphine induction for chronic pain in a pediatric patient with SCD.
Irwin M; Gunther W; Keefer P; Saul D; Singh S; Wright J; Smith M
Journal of Pain and Symptom Management
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpainsymman.2021.04.007" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2021.04.007</a>
Retrospective Review of the Use of Transdermal Buprenorphine Patches (Butrans) in a Pediatric Population
buprenorphine; buprenorphine transdermal patch; pain; transdermal
Background: Buprenorphine is an opioid medication used for the treatment of moderate to severe pain. In Canada, buprenorphine is not indicated for use in the pediatric population and literature surrounding its use in pediatrics is limited. Our aim was to evaluate the safety of transdermal buprenorphine in a pediatric palliative care setting.Methods: Our study was performed at the IWK Health Centre. Medical records of 11 patients were examined for specific clinical characteristics. The study focused primarily on descriptive results; standard data analyses were not performed.Results: Buprenorphine was found to be well tolerated in our patient population. There were no adverse effects reported in 8 of 11 patients during their treatment with buprenorphine. The remaining 3 patients described mild adverse effects in the form of skin irritation which resolved with topical steroid treatment. Efficacy was reported as anecdotal quotes from patient records.Conclusion: In this study, the use of buprenorphine in this setting was safe in a small group of patients, with the only mild adverse effect noted being a contact dermatitis in 3 patients which resolved quickly. Other studies have also demonstrated buprenorphine to be a safe and an effective opioid for the treatment of severe pain at the end of life in a pediatric population. Given these results, the implementation of buprenorphine in pediatrics may be safe for use in patients who are unable to tolerate traditional opioid analgesic therapies.
Smyth M; Haupt T S; Gregoire M C
Journal of Palliative Medicine
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/jpm.2019.0381" target="_blank" rel="noreferrer noopener">10.1089/jpm.2019.0381</a>