Naing, C., Aung, K., Racloz, V., & Yeoh, P.N. (2013). Safety and efficacy of transdermal buprenorphine for the relief of cancer pain. Journal of Cancer Research and Clinical Oncology, 139, 1963–1970.

STUDY PURPOSE: To determine the efficacy and safety of transdermal buprenorphine for treating cancer pain

TYPE OF STUDY: Meta-analysis a systematic review

DATABASES USED: MEDLINE, EMBASE, CINAHL, and the Cochrane Library up to May 2013

KEYWORDS: Search terms for the cancer type, including gastrointestinal, bladder, breast, stomach, colon, prostate, and lung; search term for buprenorphine

INCLUSION CRITERIA: Patients with cancer; RCTs; comparison of transdermal buprenorphine to placebo or any comparator drug; changes in cancer pain intensity measured by verbal rating scales, visual analog scales, numerical rating scales, or questionnaires

EXCLUSION CRITERIA: Sample size of less than 10 patients; pain that was not directly linked to the development of cancer or its treatment (i.e., chemotherapy-induced neuropathic pain); pain related to surgical procedures

TOTAL REFERENCES RETRIEVED = 212

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The quality of the studies was assessed by two reviewers using the domain-based evaluation.

• FINAL NUMBER STUDIES INCLUDED = 8 studies
• SAMPLE RANGE ACROSS STUDIES = 17–189
• TOTAL PATIENTS INCLUDED IN REVIEW = 909 patients
• KEY SAMPLE CHARACTERISTICS: Not reported

• PHASE OF CARE: Multiple phases of care     
• APPLICATIONS: Palliative care

Two studies of patients whose pain relief was at least satisfactory at all time points found a significant difference between transdermal buprenorphine and placebo in all three doses of transdermal buprenorphine, 35.5, 52.5, or 70 micrograms per hour (RR 1.74, 95% Cl 1.31–2.32; I² 0%). Pain-free sleep was improved in two studies comparing transdermal buprenorphine to placebo (RR 1.25, 95% Cl 0.84–1.88; I² 0%). Adverse effects such as nausea, vomiting, and constipation were less with transdermal buprenorphine compared to fentanyl, morphine, or placebo.

Transdermal buprenorphine appears to be an effective and safe treatment for cancer pain; however, further research is needed to confirm its effectiveness because of the low quality of published research. Information about the following research quality indicators was unclear for a majority of the studies.

• Random sequence generation
• Allocation concealment
• Blinding of participants
• Blinding of outcome assessment

• A major limitation of this meta-analysis is that few studies used the same outcome measurement, so pooling of outcome data was problematic.
• Follow-up of treatment effect was short (i.e, 15 days or less).

Although transdermal buprenorphine has been shown to have advantages over other opioids (i.e., noninvasive route, reduced respiratory depression, less frequent adverse effects), further research is needed to confirm its level of effectiveness in relieving cancer pain. In addition, the long-term effects of transdermal buprenorphine need to be determined. If nurses are caring for patients who are prescribed transdermal buprenorphine, they should be aware of the potential adverse effects, which are similar to other opioids.