Session Information
Session Title: AA 2022 Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Gizelda T. Casella, MD, PhD: No financial relationships or conflicts of interest
Background and/or Objectives: To investigate the response to the mu-opioid receptor partial agonist buprenorphine in SCID patients with severe NP receiving a combination of therapeutics (pharmacological and non-pharmacological).
Design: Prospective Observation Study
Setting: SCID inpatient and outpatient clinic
Participants: Sixteen SCID patients with NP (score≥4 by DN4), pain intensity≥5 (Verbal Numerical Rating Scale) undergoing additional pain management (pharmacological and non-pharmacological). NP in these patients failed control before initiation of buprenorphine.
Interventions: Administration of buprenorphine (dose ranged from 300 mcg/day to 24 mg/day) until adequate pain control (pain ≤ 5) with or without rescue full agonist opioids.
Main Outcome Measures: Verbal Numerical Rating Scale and rescue opioid usage.
Results: Two patients withdrew due to side-effects (somnolence, racing thoughts). Fourteen patients (mean=63 yo, 8 tetraplegia, all males, 1 injury < 2 years, 11 traumatic) were evaluated; 9 had other non-NP, 8 were below level, 1 at-level, and 5 a combination of above/ below level, 11 were taking full-agonist opioids for breakthrough pain and all patients were receiving stable doses of other medications for NP such as pregabalin/gabapentin, serotonin-norepinephrine reuptake inhibitor, antidepressant tricyclics. Initial pain was 7.9±1.5 (mean±SD) and post-treatment was 4.2±1.5 (P=0.0001 paired T-test, 43.6% improvement, range 0% to 80%) and decrease of 62.9% in full-agonist opioid use for breakthrough pain. The interval studied was 147.4±82 days. Side effects were tolerable (fatigue, nausea). Nine patients were satisfied, four were still in the titration phase, one died (unrelated cause) and did not complete treatment.
Conclusions: Buprenorphine with or without full-agonist opioids for breakthrough pain was effective in treating severe refractory SCID NP and should be considered as an effective option to control NP in association with standard treatment.
Level of Evidence: Level II
To cite this abstract in AMA style:
Casella GT, Cabrera J, Leung E. Treatment of Refractory Neuropathic Pain (NP) in Spinal Cord Injury and Disorders (SCID) with Buprenorphine: A Pilot Study [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/treatment-of-refractory-neuropathic-pain-np-in-spinal-cord-injury-and-disorders-scid-with-buprenorphine-a-pilot-study/. Accessed May 3, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-refractory-neuropathic-pain-np-in-spinal-cord-injury-and-disorders-scid-with-buprenorphine-a-pilot-study/