JAMA Intern Med

Pain and opioid reduction outcomes similar regardless of buprenorphine switch

February 20, 2025

When given the option to switch from high-dose opioids to buprenorphine, patients showed small improvements in pain relief and reduced opioid use. However, similar outcomes were observed regardless of whether patients switched medications.

Study details: This pragmatic, multisite, 12-month randomized trial involved 207 patients treated at VA clinics with moderate to severe chronic pain despite high-dose opioid therapy (≥70 mg/d for at least 3 months). Participants were randomized to either have the option to switch to buprenorphine or continue their current opioid regimen. The primary outcome was the Brief Pain Inventory (BPI) total score at 12 months, and the secondary outcome was opioid dose in morphine milligram equivalents (MME) at 12 months.

Results: Of the 104 patients in the buprenorphine option arm, 27 (26.0%) switched to buprenorphine. Both groups showed small improvements in pain scores: the buprenorphine option arm improved from 6.8 to 6.1 (adjusted mean difference [AMD], -0.59; 95% confidence interval [CI], -0.89 to -0.29), and the no option arm improved from 6.8 to 6.3 (AMD, -0.50; 95% CI, -0.81 to 0.20). Opioid dosage decreased significantly in both groups, with a reduction from 157 mg/d to 94 mg/d in the buprenorphine option arm (AMD, -61.0 mg/d; 95% CI, -74.1 to -47.9) and from 165 mg/d to 107 mg/d in the no option arm (AMD, -58.5 mg/d; 95% CI, -71.6 to -45.4).

Source:

Becker WC, VOICE Study Group, et al. (2025, February 17). JAMA Intern Med. Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/39960730/