Azar Pouya, Kim Jane J, Azarmju Farbod, Sirohi Koviya, Machado Jessica, Lau Anthony, Siu Jacky, Ignaszewski Martha J, Montaner Julio S G, Krausz Michael
Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada.
Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Subst Use. 2025 Jun 14;19:29768357251343612. doi: 10.1177/29768357251343612. eCollection 2025 Jan-Dec.
Pain is a significant clinical challenge among patients with opioid use disorder (OUD), and management strategies remain diverse and controversial. This scoping review aimed to describe and evaluate the different types of pharmacologic pain management strategies for patients who are prescribed extended-release buprenorphine (BUP-XR) for OUD and experiencing pain.
The databases Ovid Medline, EMBASE, CINAHL, Web of Science, and PsycInfo were searched from their inception to February 2025 for relevant articles. All articles that discuss the treatment of acute or chronic pain among patients receiving BUP-XR were included. Data on the key outcomes of pain severity, related functioning, patient satisfaction, and adverse events were extracted and study quality was rated independently by the authors.
The initial search yielded 980 articles. Of those, 56 were assessed for full-text review and a total of 6 articles met inclusion criteria for the study. The overall strength of the evidence was poor, consisting mainly of case series and case reports. Most studies achieved adequate pain control through the continuation of BUP-XR and the combination of full opioid agonists and non-opioid adjuncts, adjunct use of nonsteroidal anti-inflammatory drugs, conversion to sublingual buprenorphine, or performing surgery at trough serum buprenorphine concentration. No cases of respiratory depression or toxicity were observed.
This review confirmed that clear guidelines on how to support pain management in BUP-XR treatment have yet to be identified. The majority of clinicians favored a multimodal analgesic approach combining opioids, non-opioid analgesics, and regional anesthesia. Further studies, including high-quality evidence through randomized controlled trials, are needed to find and evaluate optimal adjunctive medications and define overall strategies.
疼痛是阿片类药物使用障碍（OUD）患者面临的一项重大临床挑战，管理策略仍然多种多样且存在争议。本范围综述旨在描述和评估为患有OUD且正在经历疼痛的患者开具长效丁丙诺啡（BUP-XR）时，不同类型的药物性疼痛管理策略。
检索数据库Ovid Medline、EMBASE、CINAHL、Web of Science和PsycInfo，从其创建至2025年2月，查找相关文章。纳入所有讨论接受BUP-XR治疗的患者急性或慢性疼痛治疗的文章。提取疼痛严重程度、相关功能、患者满意度和不良事件等关键结局的数据，作者独立评定研究质量。
初步检索得到980篇文章。其中，56篇文章接受全文评估，共有6篇文章符合该研究的纳入标准。证据的总体强度较差，主要包括病例系列和病例报告。大多数研究通过持续使用BUP-XR、联合使用全阿片类激动剂和非阿片类辅助药物、辅助使用非甾体抗炎药、转换为舌下丁丙诺啡或在丁丙诺啡血清谷浓度时进行手术，实现了充分的疼痛控制。未观察到呼吸抑制或毒性病例。
本综述证实，关于如何在BUP-XR治疗中支持疼痛管理的明确指南尚未确定。大多数临床医生倾向于采用联合阿片类药物、非阿片类镇痛药和区域麻醉的多模式镇痛方法。需要进一步开展研究，包括通过随机对照试验获得高质量证据，以寻找并评估最佳辅助药物，并确定总体策略。
