Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Optimising cancer breakthrough pain management: the role of short-acting sublingual buprenorphine in Supportive and Palliative Care (126303)

Katarzyna Chmiel 1 , Yanni Loh 1 , Sarah Bishop Browne 1 , Pijush Sarker 1 , Olfat Zekry 2
  1. Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  2. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Background/Rationale:

Breakthrough pain(BP) is transitory pain that occurs despite the use of opioids for background control. It affects 40%-80% of patients with cancer pain. Despite regular analgesic therapy, patients often feel that their pain is not sufficiently controlled. Concurrent concerns about dependence, neurotoxicity, tolerance and escalating opioid requirements remain problematic. Therefore, an improved understanding of BP management and toxicity profile of short acting analgesics is essential for cancer clinicians.

 

Methods:

Two case presentations demonstrating advantages of sublingual buprenorphine will be presented, alongside review of mechanisms of action, approaches to BP prescribing and opioid rotations to optimise analgesia and reduce opioid toxicity.

 

Discussion:

Buprenorphine is a synthetic partial μ-opioid receptor(MOR) agonist for treatment of pain and opioid use disorder. It diminishes cravings and improves QOL during addiction treatment by mitigating symptoms of opioid withdrawal in the setting of opioid drug dependence1.

 

In the setting of oncology and supportive and palliative care(SPC), the favourable pharmacokinetic profile of sublingual buprenorphine should be taken full advantage of – high binding affinity to MOR and slower dissociation allow for effective and rapid onset analgesia and prolonged period of action, while the partial MOR agonism results in less respiratory depression2,3. Due to effects on other opioid receptors buprenorphine results in less sedation, constipation, misuse and cognitive impairment than traditional opioids3, reducing the overall neurotoxicity risk. However, due to stigma related to its use in opioid dependence and lower accessibility, buprenorphine remains underutilised.

 

Impact:

Optimising BP analgesia and functional wellness, while minimising neurotoxicity and other side effects of analgesics in patients with advanced cancer remains a common clinical challenge. Sublingual Buprenorphine offers clinical advantages in its action and favourable toxicity profile but remains underutilised in oncology and SPC. Increasing clinicians’ practical knowledge of buprenorphine safety and action will foster a reliable and tolerable approach to BP management.

  1. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. 2024 Jun 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29083570.
  2. Chapter 18 p 354-368. Nonintravenous opioids. "Pharmacology and Physiology for Anesthesia": https://doi.org/10.1016/B978-0-323-48110-6.00018-1 https://www.sciencedirect.com/book/9780323481106/pharmacology-and-physiology-for-anesthesia
  3. Jackson LK, Poon IO, Garcia MA, Imam S, Braun UK. Buprenorphine Use for Analgesia in Palliative Care. Pharmacy (Basel). 2024 May 13;12(3):78. doi: 10.3390/pharmacy12030078. PMID: 38804470; PMCID: PMC11130940