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Evaluation of Flexible Buprenorphine Dosing in Patients with Chronic Pain

P-024 - (Poster #24) Evaluation of Flexible Buprenorphine Dosing in Patients with Chronic Pain

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background: Chronic pain is a common debilitating condition affecting over 81 million adults in the United States.  Historically, opioid medications were the mainstay treatment for chronic pain, despite a lack of evidence in support of or advisement against their long-term use. Buprenorphine is a mixed µ-opioid agonist that is safer for long-term use compared to full agonist opioid medications. Buprenorphine is a safer alternative to full µ-opioid agonists because of a reduced risk of  adverse events as well as a ceiling effect on respiratory depression. Although buprenorphine is a long-acting medication, it has short-acting pharmacokinetic properties allowing it to be useful in management of acute, breakthrough pain due to its quick onset. While there is general guidance for buprenorphine in chronic pain, there is no literature to describe dosing regimens or the potential for flexible buprenorphine dosing in this population. 

Purpose/Objectives: While buprenorphine’s short-acting analgesic properties are well established, the utilization of buprenorphine for its short-acting effects for outpatient chronic pain management has not been established in the literature. Use of buprenorphine for breakthrough pain can reduce full µ-opioid agonist needs, reduce adverse effects from LTOT, and improve pain control. The purpose of this study is to characterize different buprenorphine regimens used for chronic pain and their longevity and tolerability benefits. 

Methods: This was a retrospective single center, observational study. Inclusion criteria were age 18 and older, diagnosis of chronic pain, and prescribed buprenorphine between January 2023 and August 2024. Patients with a concomitant diagnosis of opioid use disorder (OUD) were excluded. Four buprenorphine regimens were analyzed: scheduled buprenorphine, scheduled plus as needed (PRN) buprenorphine, PRN buprenorphine alone, and scheduled buprenorphine plus PRN full µ-opioid agonist. The primary outcome was the percent of patients on each buprenorphine regimen and the secondary outcome was duration of buprenorphine therapy. 

Results: Overall, 691 patients were reviewed, with 401 meeting inclusion criteria. Scheduled buprenorphine was prescribed to 340 patients (84.4%), while 37 patients (9.2%) were prescribed scheduled plus PRN buprenorphine. Patients exposed to flexible dosing remained on treatment longer than those on scheduled buprenorphine alone (HR 3.50, CI 2.07-5.92, NNT 9.0).

Conclusions/Implications for future research and/or clinical care: The study demonstrated that flexible buprenorphine dosing was utilized for chronic pain. Patients on scheduled plus PRN buprenorphine were on treatment longer than those on scheduled buprenorphine alone or scheduled buprenorphine plus PRN full agonist.  Scheduled plus PRN buprenorphine can be considered for patients with chronic pain.