University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Pain Medicine


Dr. James Shuler



Chronic pain affects over 20% of the United States adult population and disproportionately impacts those over the age of 65. While not considered the first-line, opioid therapy may be one of the few treatment options for this patient population. Considerations of such medical therapy require a careful assessment of risks such as respiratory depression and dependency, as well as, potential benefits which include improving both quality of life and functional status. With patient safety at the forefront of these considerations, buprenorphine presents as a safer opioid for use given its favorable pharmacologic profile including ceiling effect for respiratory depression and less abuse potential as a Schedule III controlled substance. When considering buprenorphine for chronic pain there are two approved formulations at this time including the transdermal and buccal preparation. These medications have several available doses for ease of titration for opioid-naive patients or conversion to buprenorphine for patients already taking a full μ-opioid agonist. In the case of transition to buprenorphine for patients currently on chronic opioid therapy, conversion to buprenorphine can be accomplished via potential tapering if required and then transition to either transdermal or buccal buprenorphine utilizing morphine milligram equivalent conversions. The primary goal of this endeavor is to expand knowledge regarding the utilization of buprenorphine in chronic pain and expound upon the evidence which supports buprenorphine as a safer opioid medication for use in the chronic pain population.

Learning objectives

  • Describe the pharmacology of buprenorphine and schedule classification.

  • Outline approach for initiation of buprenorphine in opioid-naive patients.

  • Understand approach for transitioning patients who are already taking full μ-opioid agonists.


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