Acute pain treatment in patients with sickle cell disease transitioned to buprenorphine: evidence of equivalent pain relief

Abstract Objectives Buprenorphine is a novel opioid analgesic with complex receptor pharmacology. It is safer than high dose chronic treatment with full agonist opioids. However, buprenorphine can inhibit conventional opioids, complicating acute pain treatment. Methods We compare acute pain treatment outcomes in 55 sickle cell disease patients in the year before and after transition to buprenorphine. Infusion center visits, ED visits, and hospital admissions were compared before and after transition, and pain outcomes were compared using linear mixed effects models with patients entered as random effects to account for differential contribution to the outcomes by visit rates. Results Acute care visits reduced markedly (mean 12.15 visits per patient, SD 12.41; to 5.18, SD 5.77). In all acute care settings, opioid agonist use reduced. For infusion center and inpatient visits; initial pain severity scores, pain relief, and time treated were similar before and after transition to buprenorphine. For the ED, the reduction in visits was greater, though per-visit pain relief was not as robust as other settings. However, after induction patients also presented to the ED with less severe pain and reached the same final pain severity. Non-opioid pharmacotherapy for acute pain was similar pre- and post-induction in all settings. Conclusion In a multidisciplinary adult sickle cell center with experience in complex pain treatment, patients transitioned to buprenorphine have fewer acute care visits and similar acute pain outcomes; with the main difference in acute pain treatment being the use of combinations of buprenorphine and full opioid agonists.