Patients With Chronic Pain Report Mostly Positive Experiences Transitioning to Buprenorphine From Long-Term Opioid Therapy, With Important Caveats

The risks of full agonist long-term opioid therapy for chronic pain—and those of tapering off of these medications—make a transition from full agonists to buprenorphine an attractive and potentially safer option for some patients. This study in two US Department of Veterans Affairs pain care sites used qualitative semi-structured interviews with 19 patients currently prescribed buprenorphine to understand the experiences of patients with chronic pain who transitioned to buprenorphine after being prescribed full-agonist opioid therapy for at least one year.

• Most patients found buprenorphine equally or less effective for pain than full agonist opioid medications, but improved overall function and fewer side effects made most feel that buprenorphine was a better choice for them.
• Patients with opioid-related harm or openness to new approaches to pain management were more satisfied than the single patient who felt coerced to switch.
• The transition period was generally uncomplicated, but some patients recalled increased pain and short-term side effects during buprenorphine initiation and dose-finding.
• Transparent, patient-centered, non-judgmental provider communication and education about the transition to buprenorphine at least partially eased patient concerns.
• In marked contrast with other patients, all three Black patients in the study reported difficulty accessing any type of pain medication, being denied opioid pain medication prior to finding buprenorphine as an option, and stigma from some medical providers.

Comments: While this study documents mostly positive patient narratives about their transition to buprenorphine from full agonist opioid medications for chronic pain, the inclusion of only patients currently prescribed buprenorphine risks missing additional negative narratives. Given the complexity and stigma surrounding chronic pain management with opioids, especially in the context of structural racism, the importance of non-judgmental communication and emphasis on patient-centered outcomes cannot be overemphasized.

Joseph Merrill, MD, MPH

Reference: Edmond SN, Wesolowicz DM, Snow JL, et al. Qualitative analysis of patient perspectives of buprenorphine after transitioning from long-term, full-agonist opioid therapy among veterans with chronic pain. J Pain. 2024;25(1):132–141.