Use of a buprenorphine-based pain management protocol is associated with reduced opioid requirements and pain on swallowing in oral mucositis: a retrospective cohort study.

2022-07

Meyer, Ilonka

Chan, Brandon

Cohen, Emma

Dube, Esther

Hu, Raymond T C

Yeomans, Megan

Pontonio, Frances

Heldreich, Charlotte

O'Conghaile, Stiofan

Holmes, Natasha E

Maroon, Nada

Weinberg, Laurence

Tan, Chong O

Acute pain

Buprenorphine

Cancer pain

Opioid

Oral mucositis

Stem cell transplant

Journal Article

0000-0002-8025-9519

0000-0002-0169-0600

0000-0003-2423-9385

0000-0003-1161-8239

0000-0002-2194-9915

0000-0001-8501-4054

0000-0001-7403-7680

10.1007/s00520-022-07014-5

The aim of this study is to ascertain the analgesic efficacy and total oral morphine equivalent daily dose (OMEDD) effect of a buprenorphine-based analgesic protocol in the treatment of severe Oral Mucositis (OM). This is a retrospective cohort study. This study was done in a single Quaternary Referral Centre, Haematology Unit. Fifty-four stem cell transplant patients suffering at least grade 3 oral mucositis (OM), 24 prior to [Pr-I] and 30 subsequent to [Po-I] a buprenorphine-based OM analgesic protocol. We analysed data from the above subjects with the primary outcome measure of difference in total OMEDDs from all opioid types and administration routes, and secondary outcome measures of area under the curve (AUC) of 11-point Numerical Rating Scale (NRS-11) pain assessments, sedation scores and respiratory rate. Post-protocol patients' total OMEDD requirements were significantly reduced [Pr-I: 1961 (1365)mg; Po-I: 928 (625)mg, p = 0.02], as were total NRS-11:hours AUC on swallowing [Pr-I: 54(24) score-hours; Po-I: 41(18) score-hours, p < 0.001]. There were no significant differences in objective measures of OM severity between groups (Number of Grade 3 or 4 OM severity assessments [mean (SD)] Pr-I: 5 (6.2); Po-I: 7 (5.1) or number of days Neutrophil count 0.0 or 0.1 × 109/L; Pr-I: 13 (5.4); Po-I: 15 (4.7)). 5 Pr-I and 4 Po-I patients required ketamine infusions, with 1 Pr-I patient also requiring IV lignocaine. Use of Buprenorphine via transdermal, sublingual and intravenous Patient Controlled Analgesia (PCA) delivery as part of an analgesic protocol for severe post stem cell transplant oral mucositis in adult patients appears to significantly reduce opioid requirements and pain on swallowing. Further randomised prospective work is required to confirm these associations.

link

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2022; 30(7): 6013-6020

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer