Sublingual Buprenorphine as an Analgesic in Chronic Pain: A Systematic Review

Objective. There is growing interest in the use of sublingual buprenorphine for the treatment of chronic pain due to the unique pharmacology of buprenorphine, widespread use of the transdermal buprenorphine patch for chronic pain, and recent availability of sublingual buprenorphine tablets for the treatment of opioid dependence. The aim of this systematic review was to evaluate the evidence from clinical trials that have assessed the effectiveness of sublingual buprenorphine for chronic pain analgesia. Methods. Electronic searches of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Database of Systematic Reviews were used to identify clinical trials of sublingual buprenorphine for the treatment of chronic pain. Results. Ten trials involving 1,190 patients were included in the review. Due to heterogeneity of studies, pooling of the results and meta-analysis were not possible. All studies reported that sublingual buprenorphine demonstrated some effectiveness as a chronic pain analgesic. The majority of studies were observational and of low quality. Conclusions. Preliminary trials suggest a plausible role; however, due to a paucity of high-quality trials, the current evidence is insufficient to determine the effectiveness of sublingual buprenorphine for the treatment of chronic pain. Rigorous further trials are warranted.