Treatment of Chronic Pain With Various Buprenorphine Formulations: A Systematic Review of Clinical Studies

Anesth Analg. 2018 Aug;127(2):529-538. doi: 10.1213/ANE.0000000000002718.


Clinical studies demonstrate that buprenorphine is a pharmacologic agent that can be used for the treatment of various types of painful conditions. This study investigated the efficacy of 5 different types of buprenorphine formulations in the chronic pain population. The literature was reviewed on PubMed/MEDLINE, EMBASE, Cochrane Database,, and PROSPERO that dated from inception until June 30, 2017. Using the population, intervention, comparator, and outcomes method, 25 randomized controlled trials were reviewed involving 5 buprenorphine formulations in patients with chronic pain: intravenous buprenorphine, sublingual buprenorphine, sublingual buprenorphine/naloxone, buccal buprenorphine, and transdermal buprenorphine, with comparators consisting of opioid analgesics or placebo. Of the 25 studies reviewed, a total of 14 studies demonstrated clinically significant benefit with buprenorphine in the management of chronic pain: 1 study out of 6 sublingual and intravenous buprenorphine, the only sublingual buprenorphine/naloxone study, 2 out of 3 studies of buccal buprenorphine, and 10 out of 15 studies for transdermal buprenorphine showed significant reduction in pain against a comparator. No serious adverse effects were reported in any of the studies. We conclude that a transdermal buprenorphine formulation is an effective analgesic in patients with chronic pain, while buccal buprenorphine is also a promising formulation based on the limited number of studies.

Publication types

  • Systematic Review

MeSH terms

  • Administration, Buccal
  • Administration, Cutaneous
  • Administration, Sublingual
  • Analgesics, Opioid / therapeutic use*
  • Buprenorphine / administration & dosage*
  • Buprenorphine, Naloxone Drug Combination / therapeutic use
  • Chronic Disease
  • Chronic Pain / therapy*
  • Clinical Trials as Topic
  • Humans
  • Methadone / therapeutic use
  • Neoplasms / pathology
  • Pain Management / methods*
  • Pain Measurement
  • Risk
  • Treatment Outcome


  • Analgesics, Opioid
  • Buprenorphine, Naloxone Drug Combination
  • Buprenorphine
  • Methadone