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Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report

Background: Due to its unique pharmacologic properties, efficacy as an analgesic, and role as a first-line medication for the treatment of opioid use disorder, sublingual buprenorphine has emerged as a treatment for patients with concurrent chronic pain and opioid use disorders. One challenge to uti...

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Autores principales: Sandhu, Raman, Zivanovic, Rebecca, Klaire, Sukhpreet, Nikoo, Mohammadali, Rozylo, Jennifer, Azar, Pouya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8730552/
https://www.ncbi.nlm.nih.gov/pubmed/35005396
http://dx.doi.org/10.1080/24740527.2019.1599279
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author Sandhu, Raman
Zivanovic, Rebecca
Klaire, Sukhpreet
Nikoo, Mohammadali
Rozylo, Jennifer
Azar, Pouya
author_facet Sandhu, Raman
Zivanovic, Rebecca
Klaire, Sukhpreet
Nikoo, Mohammadali
Rozylo, Jennifer
Azar, Pouya
author_sort Sandhu, Raman
collection PubMed
description Background: Due to its unique pharmacologic properties, efficacy as an analgesic, and role as a first-line medication for the treatment of opioid use disorder, sublingual buprenorphine has emerged as a treatment for patients with concurrent chronic pain and opioid use disorders. One challenge to utilizing buprenorphine is that precipitated opioid withdrawal can result if this medication is initiated in the presence of other opiates with lesser binding affinities. Micro-dosing induction regimens utilize a slower titration to avoid the need for a period of abstinence from other opiates and decrease the risk of precipitated withdrawal. Aims: The aim of this article is to present a case where a standardized micro-dosing induction regimen was used to transition a patient from other opiate analgesia to a sublingual formulation of buprenorphine/naloxone. Methods: This case took place on an inpatient neurosurgical unit of a Canadian tertiary-care city hospital. Written informed consent was collected prior to a detailed chart review. Results: Here we present a case of a postoperative neurosurgical inpatient who was referred to our team for pain management in the context of chronic pain and a past history of opioid use disorder. She was successfully transitioned to buprenorphine/naloxone, replacing all other opioid analgesia, without a period of opioid withdrawal using a micro-dosing induction regimen. Conclusions: Sublingual buprenorphine/naloxone can be safe and effective for treatment of chronic pain, particularly for those with past or current opioid use disorder. Micro-dosing provides a preferable induction strategy for patients who are not able to tolerate the requirement for moderate opioid withdrawal prior to initiation with existing regimens.
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spelling pubmed-87305522022-01-06 Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report Sandhu, Raman Zivanovic, Rebecca Klaire, Sukhpreet Nikoo, Mohammadali Rozylo, Jennifer Azar, Pouya Can J Pain Case Reports Background: Due to its unique pharmacologic properties, efficacy as an analgesic, and role as a first-line medication for the treatment of opioid use disorder, sublingual buprenorphine has emerged as a treatment for patients with concurrent chronic pain and opioid use disorders. One challenge to utilizing buprenorphine is that precipitated opioid withdrawal can result if this medication is initiated in the presence of other opiates with lesser binding affinities. Micro-dosing induction regimens utilize a slower titration to avoid the need for a period of abstinence from other opiates and decrease the risk of precipitated withdrawal. Aims: The aim of this article is to present a case where a standardized micro-dosing induction regimen was used to transition a patient from other opiate analgesia to a sublingual formulation of buprenorphine/naloxone. Methods: This case took place on an inpatient neurosurgical unit of a Canadian tertiary-care city hospital. Written informed consent was collected prior to a detailed chart review. Results: Here we present a case of a postoperative neurosurgical inpatient who was referred to our team for pain management in the context of chronic pain and a past history of opioid use disorder. She was successfully transitioned to buprenorphine/naloxone, replacing all other opioid analgesia, without a period of opioid withdrawal using a micro-dosing induction regimen. Conclusions: Sublingual buprenorphine/naloxone can be safe and effective for treatment of chronic pain, particularly for those with past or current opioid use disorder. Micro-dosing provides a preferable induction strategy for patients who are not able to tolerate the requirement for moderate opioid withdrawal prior to initiation with existing regimens. Taylor & Francis 2019-04-25 /pmc/articles/PMC8730552/ /pubmed/35005396 http://dx.doi.org/10.1080/24740527.2019.1599279 Text en © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Reports
Sandhu, Raman
Zivanovic, Rebecca
Klaire, Sukhpreet
Nikoo, Mohammadali
Rozylo, Jennifer
Azar, Pouya
Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title_full Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title_fullStr Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title_full_unstemmed Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title_short Buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: A case report
title_sort buprenorphine/naloxone induction for treatment of acute on chronic pain using a micro-dosing regimen: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8730552/
https://www.ncbi.nlm.nih.gov/pubmed/35005396
http://dx.doi.org/10.1080/24740527.2019.1599279
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