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- A meta-analysis of efficacy and tolerability of buprenorphine for the relief of cancer pain. [REVIEW]
- Springerplus 2014.:87.
This study aimed to synthesize available evidence on the analgesic efficacy of buprenorphine in treating cancer pain and related adverse effects. We searched electronic databases for randomized controlled trials, assessing the efficacy of buprenorphine, regardless of delivery system. The primary endpoints were patient-reported 'pain intensity' and 'pain relief'. Statistical heterogeneity among included studies was assessed with the I (2) test. The summary relative risk (RR) and 95% CI were derived, if two or more studies reported the similar outcome. Sixteen RCTs (n = 1329) with buprenorphine were included: 8 transdermal (TD), 5 sublingual (SL), 2 intramuscular injection (IM) and 1 subcutaneous infusion (SC) studies; with both SL and IM routes being assessed in one study. Only a few studies reported the same outcome in a similar way, creating difficulty for pooling of the outcome data. Many studies had a high risk of bias. In 2 studies (n = 241), the 'global impression change' was significantly different between TD buprenorphine and the combined placebo and morphine (RR 1.35, 95% CI 1.14-1.59; I (2): 42%); the 'number-needed-to-treat' (NNT) was 4.9 (95% CI: 3.1-10.9). In 2 studies (n = 331), 'requirement for rescue SL buprenorphine' was comparable between TD buprenorphine and placebo (RR 1.25, 95% CI 0.71-2.18; I (2) : 40%). In 2 studies (n = 141), 'incidence of nausea' was less in TD buprenorphine (RR: 0.38, 95% CI: 0.2-0.71, I (2): 0%, NNT: 9.3, 5.6-28.5). Due to the small number of participants in a small number of studies, the results of the present review provide insufficient evidence to position adequately the use of buprenorphine in treatment of cancer pain. Large multicenter RCTs that compare TD buprenorphine with standard analgesic treatment is needed to position TD buprenorphine in the therapeutic armamentarium of cancer pain treatment.
- Impact of research network participation on the adoption of buprenorphine for substance abuse treatment. [JOURNAL ARTICLE]
- Addict Behav 2014 Feb 7; 39(5):889-896.
There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.
- Execution of control among 'non-compliant', imprisoned individuals in opioid maintenance treatment. [JOURNAL ARTICLE]
- Int J Drug Policy 2014 Feb 7.
Strict control routines of prescribed opiate intake in opioid maintenance treatment, OMT, are used to reduce the risk of diversion and non-prescribed methadone and buprenorphine use. While maintaining a focus on aspects of control, this article explores motivations for and practices of methadone and buprenorphine use, both inside and outside of prison and among imprisoned individuals in OMT. The participants in this qualitative study were subjected to tight external control regimes in their opioid maintenance schemes in prison, as they were prior to imprisonment due to varying degrees of 'non-compliance'. We nevertheless found them to exhibit a considerable amount of self-control, self-regulation and/or self-initiation of external control. Among the participants, a ceaseless surveillance of processes associated with methadone and buprenorphine use throughout diverse situations, relations and contexts was encountered. We conclude that, in opioid maintenance treatment, some individuals might know what particular configurations of internal and external control they need in order to achieve their own treatment goals. The drug users' capacities for execution of control, as well as their delegations of control to others, may be seen as resources throughout the course of treatment.
- Behavioural treatment combined with buprenorphine does not reduce opioid use compared with buprenorphine alone. [JOURNAL ARTICLE]
- Evid Based Ment Health 2014 Mar 3.
- I heard about it from a friend: assessing interest in buprenorphine treatment. [Journal Article]
- Subst Abus 2014; 35(1):74-9.
Background:In the United States, opioid abuse and dependence continue to be a growing problem, whereas treatment for opioid abuse and dependence remains fairly static. Buprenorphine treatment for opioid dependence is safe and effective but underutilized. Prior research has demonstrated low awareness and use of buprenorphine among marginalized groups. This study investigates syringe exchange participants' awareness of, exposure to, and interest in buprenorphine treatment.
Methods:Syringe exchange participants were recruited from a mobile unit performing outreach to 9 street-side sites in New York City. Computer-based interviews were conducted to determine (1) opioid users' awareness of, exposure to, and interest in buprenorphine treatment; and (2) the association between awareness or exposure and interest in buprenorphine treatment. Logistic regression models were used to examine the associations between awareness of, direct exposure (i.e., having taken buprenorphine) or indirect exposure (i.e., knowing someone who had taken buprenorphine)S to, and interest in buprenorphine treatment.
Results:Of 158 opioid users, 70% were aware of, 32% had direct exposure to, and 31% had indirect exposure to buprenorphine; 12% had been prescribed buprenorphine. Of 138 opioid users who had never been prescribed buprenorphine, 57% were interested in buprenorphine treatment. In multivariate models, indirect exposure was associated with interest in buprenorphine treatment (adjusted odds ratio [AOR] = 2.65, 95% confidence interval [CI]: 1.22-5.77), but awareness and direct exposure were not.
Conclusions:Syringe exchange participants were mostly aware of buprenorphine and interested in treatment, but few had actually been prescribed buprenorphine. Because indirect exposure to buprenorphine was associated with interest in treatment, future interventions could capitalize on indirect exposure, such as through peer mentorship, to address underutilization of buprenorphine treatment.
- The effects of an intravenous bolus of dexmedetomidine following extubation in a mixed population of dogs undergoing general anaesthesia and surgery. [JOURNAL ARTICLE]
- Vet J 2014 Jan 31.
An observer blinded, placebo controlled study evaluated the effects of 62.5μg/m(2) dexmedetomidine administered IV on recovery from isoflurane anaesthesia in dogs. Forty-four healthy dogs, weighing 1.8-19.95kg, presented for surgery that was expected to cause mild to moderate pain were studied. All were premedicated with 125μg/m(2) dexmedetomidine and 20μg/kg buprenorphine IM. Anaesthesia was induced with propofol and maintained with isoflurane. Non-steroidal anti-inflammatory drugs and local anaesthetics were administered as appropriate. Immediately prior to extubation dogs were treated with dexmedetomidine 62.5μg/m(2) (group D) or an equivalent volume of heparinised saline (S). Assessments of heart rate, respiratory rate, pain (short form Glasgow composite pain scale [SF-GCPS], dynamic interactive visual analogue scale [DIVAS]), sedation (simple descriptive scale [SDS], DIVAS) and mechanical nociceptive threshold (MNT) were performed immediately before premedication, 20min later, at the time of test drug administration (T0) and at 15-30min intervals for four hours (T240min). Recovery quality was scored 0 - 3 (SDS). Data were analysed with Student's t and Mann-Whitney U tests, two-way ANOVA and Fisher's exact test. Significantly fewer poor quality recoveries were observed in group D (D 2 [1-3]; S 2 [0-3]; P=0.02), however, sedation was increased in group D compared to group S from T15 to T150min (P=0.0001). Pain scores were lower in group D compared to group S from T15 to T120min (P=0.001), but the requirement for additional analgesia in the first 4h following extubation was not different between groups. Dexmedetomidine may decrease the incidence of poor quality anaesthetic recoveries in dogs.
- Buprenorphine versus tramadol as perineural adjuvants for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair under middle interscalene block. A retrospective study. [JOURNAL ARTICLE]
- Minerva Anestesiol 2014 Feb 25.
Background: The aim of this retrospective study was to compare buprenorphine and tramadol, in order to assess their different efficacy in prolonging postoperative analgesia and their associated side effects when used as perineural adjuvants with a local anaesthetic. Methods. The clinical records of 161 consecutive ASA 12 adult patients scheduled for arthroscopic rotator cuff repair and fulfilling the inclusion/exclusion criteria were reviewed retrospectively. The anaesthesia was performed using the middle interscalene block (MIB). The 161 patients were divided into three groups (A, B, T) according to their utilization of buprenorphine (B), tramadol (T) or neither of the latter (A) as perineural adjuvants: Group A (54 patients): levobupivacaine 0.75%, 0.4 ml/kg; Group B (56 patients): levobupivacaine 0.75%, 0.4 ml/kg + 0.15 mg buprenorphine; Group T (51 patients): levobupivacaine 0.75%, 0.4 ml/kg + 100 mg tramadol. Results. The results showed that the group treated with buprenorphine benefited from a longer postoperative analgesia than that treated with local anaesthetic alone (P<.0001). Otherwise, a less evident not statistically significant (P = 0.4825) difference turned out between the group treated with the anaesthetic alone and the group treated with tramadol as adjuvant. no difference turned out to be between the local anaesthetic alone treatment and the tramadollocal anaesthetic one (P = 0.4825; HR = 0.863, 95% CI 0.5741.299); on the contrary, a significant difference was demonstrated between the buprenophinelocal anaesthetic group and the local anaesthetic alone one (P<.0001; HR = 0.330, 95% CI 0.2160.530) Conclusion. Both buprenorphine and tramadol are effective as perineural adjuvants used in order to prolong the postoperative analgesia, buprenorphine proving more efficacious for this purpose than tramadol.
- Attitudes of Swiss veterinarians towards pain and analgesia in dogs and cats. [Journal Article]
- Schweiz Arch Tierheilkd 2014 Mar 1; 156(3):111-7.
A survey was performed to evaluate the use of perioperative analgesia in dogs and cats by veterinary practitioners. Questions were grouped in seven sections recording personal data, education in veterinary analgesia, general ideology regarding treatment of perioperative pain, personal experience, assessment, and use of main analgesics to treat perioperative pain. A total of 258 received forms were analyzed. Based on 5 questions, 88 % showed excellent motivation to use perioperative pain therapy. The main reason declared for the use of analgesics was to relieve the patient from pain (64.1 %). Most veterinarians reported to routinely administer analgesics before (71 - 96 %) or after (2 - 23 %) surgery. The most used analgesics were non-steroidal anti-inflammatory drugs (carprofen, meloxicam) and opioids (butorphanol, buprenorphine). Animals were routinely evaluated for pain after recovery. Only 43.8 % of veterinarians declared to use loco-regional anaesthesia. Swiss veterinarians appear to recognize well the need for perioperative pain treatment. However, weakness was shown in evaluating pain severity, distinguishing between opioid classes, and using loco-regional anaesthesia.
- Hollow fiber liquid-phase microextraction combined with ultra-high performance liquid chromatography-tandem mass spectrometry for the simultaneous determination of naloxone, buprenorphine and norbuprenorphine in human plasma. [Journal Article]
- J Chromatogr B Analyt Technol Biomed Life Sci 2014 Mar 1.:157-63.
A hollow fiber liquid phase microextraction (HF-LPME) combined with ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method was developed for the extraction and determination of naloxone (NLX), buprenorphine (BP) and its major metabolite norbuprenorphine (NBP) in human plasma. The optimum extraction conditions of HF-LPME were: the porous of polyvinylidene fluoride (PVDF) hollow fiber was full of component solvent (1-octanol/chloroform/toluene, 2/4/4), the pH of donor phase was 8.7, the extraction time was 30min and stirring speed was 1000 revolutions per minute (rpm). The UHPLC-MS/MS method was performed with Waters ACQUITY UPLCTM BEH C18, 50mm×2.1mm, 1.7μm, using methanol-0.2%formic acid as mobile phase with a gradient elution at a flow rate of 0.25mL/min. The target compounds were detected under a tandem quadrupole mass spectrometer in positive electrospray ionization (ESI) mode, then analyzed in multiple reaction monitoring (MRM) mode and the isotope internal standard method was used for quantification. The results showed that linearities were in the range of 0.1-25ng/mL (R>0.996). The limits of detection (LOD) of BP/NBP/NLX were 0.05/0.05/0.025ng/mL and the limits of quantitation (LOQ) of BP/NBP/NLX were 0.1/0.1/0.05ng/mL, respectively. The spiked recoveries were in the range of 92.1-106.0% with relative standard deviation (RSD) values were less than 15%. This method was simple, inexpensive, sensitive and has been successfully used to quantify plasma samples from patients included in a clinical pharmacogenetic study.
- Buprenorphine/Naloxone treatment in the correctional setting: use or misuse. [Journal Article]
- Innov Clin Neurosci 2013 Nov; 10(11-12):13-4.