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Why isn't buprenomorphine used more often for pain relief?

Q) I'm 86 years of age and have osteoarthritis of the spine. Over several years I've been prescribed various painkillers including co-proxamol, solpadol, voltarol, and so on. None of them were much good. My doctor prescribed Butrans at the first level of 5 mg of buprenomorphine. From the beginning it worked marvellously. That was 18 months ago. Of course, I still have arthritis but I don’t know about it; I'm pretty well pain-free. I'd be interested to know why this isn't used more for pain relief, and if after some length of time there might be unacceptable side-effects?
Anthony Palmer, Ringwood, Hampshire (Winter 2009)

A) Thank you for passing on this positive message, it's always good to hear such news in clinic and certainly in this column. You're referring to the transdermal patch called Butrans, a relatively new formulation of an old drug for pain and, of course, it doesn’t suit everyone. It can make you sickly or drowsy, but giving it by a patch means that some of the side-effects associated with the drug in tablet form can be avoided. Buprenomorphine is one of the opiate drugs that's related to and works like morphine so has the potential for addiction. However, it's thought that if the drug is taken for pain (rather than for pleasure) addiction is much less likely to occur.


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