Dr James Schaller
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Transdermal Buprenorphine For Chronic Pain

For the last decade I have been exploring the ability of replacing about 60-90 oral, IM, or IV medications, along with essential minerals and other nutrients, and transforming them into a transdermal delivery mode. For example, making an injectable antibiotic shot become a transdermal cream. In many instances, such as nausea from oral antibiotics or nausea medications, this seemed a profoundly obvious solution.

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The transdermal matrix patch formulation of buprenorphine has been shown to be effective in managing moderate-to-severe cancer pain and severe pain unresponsive to nonopioid analgesics. Clinical trials have revealed that it is possible to switch from weak opioids or low doses of step III opioids to transdermal buprenorphine without any problems. With buprenorphine patches, the sublingual buprenorphine intake was dose-dependently reduced and was superior to placebo in this respect. The proportion of responders increased with the buprenorphine dose, and a higher proportion of patients receiving buprenorphine patches reported uninterrupted sleep for longer than 6 h compared with those receiving placebo. In a long-term, open, follow-up study in which the mean duration of treatment was 7.5 months, analgesia was rated as at least satisfactory by 90% of patients. Almost 60% of patients could manage their pain with one patch alone or with one additional sublingual tablet a day during the whole period of treatment, indicating a low incidence of tolerance development. The buprenorphine transdermal patch was assessed as user friendly by 94.6% of patients. In a postmarketing surveillance study, pain relief with transdermal buprenorphine was rated as good or very good by 70% of the responders. Postmarketing surveillance studies have shown that transdermal buprenorphine is also effective in the management of nociceptive and neuropathic pain, which some studies have shown to be relatively insensitive to mu-opioid analgesics, such as morphine. Transdermal buprenorphine was well tolerated. Most adverse events were either local reactions to the patch that generally subsided within 24 h or systemic events typical of treatment with opioid analgesics, such as nausea, vomiting and constipation.

Sittl R. Transdermal buprenorphine in the treatment of chronic pain. Expert Rev Neurother. 2005 May;5(3):315-23.

It appears that yet another medication option found in an advanced country is not available in the USA. It is good to know the FDA is attacking Canadian pharmacies with affordable medications, attacking master compounders who tailor medications to your needs and are constantly impinging on the nutrient market, and yet cannot make it so excellent products like this patch are in the land of "liberty."

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