Buprenorphine for the treatment of pain in patients with central nervous system tumors: A case series

Background: Patients with CNS tumors have high rates of chronic cancer pain and headache but are more sensitive to cognitive and sedation side effects from full-opioid agonists. Buprenorphine, a partial opioid agonist, offers potential advantages over full agonist opioids but real-world insights on prescribing patterns is lacking. This study examines prescribing patterns, clinical use, and pain score changes associated with buprenorphine use in patients with CNS tumors. Methods: We retrospectively analyzed the clinical notes of 28 primary or secondary patients with CNS tumors, seen in the neuro-oncology outpatient clinic of a comprehensive cancer center, who had a record of being prescribed buprenorphine for pain. We collected information on patients' buprenorphine use, formulation, dosage, duration, adverse effects, discontinuation reason, and information on what opioids they took before and after buprenorphine. Results: The average age was 57 years old and 71% were female. Most (82%) patients were taking short-acting full-agonists prior to being prescribed buprenorphine, with oxycodone being the most prescribed opioid. Among the 19 patients who had pain scores available, the median change in pain score -3 points (5 to 2 out of 10). Patients were prescribed buprenorphine for an average of 137 days. The transdermal patch was the most prescribed formulation. The most common uses were for headache (10; 39%), back pain (9; 35%), and chronic/diffuse pain (8; 31%). Conclusion: This is the first study exploring buprenorphine use among patients with CNS tumors. Buprenorphine may be a viable analgesic option for patients with CNS tumors and warrants further prospective study.