• Joseph Gimbel, Egilius L H Spierings, Nathaniel Katz, Qinfang Xiang, Evan Tzanis, and Andrew Finn.
• aArizona Research Center, Phoenix, AZ, USA bDepartment of Neurology, Craniofacial Pain Center, Tufts University Schools of Medicine and Dental Medicine, Boston, MA, USA cAnalgesic Solutions, LLC, Natick, MA, USA dTufts University, Boston, MA, USA eEndo Pharmaceuticals Inc, Malvern, PA, USA fFormerly of Endo Pharmaceuticals Inc, Malvern, PA, USA gBioDelivery Sciences International Inc, Raleigh, NC, USA.
• Pain. 2016 Nov 1; 157 (11): 2517-2526.

AbstractA buccal film of buprenorphine (BBUP) was evaluated for safety and efficacy in a multicenter, double-blind, placebo-controlled, enriched-enrollment, randomized-withdrawal study in opioid-experienced patients (30 to ≤160 mg/d morphine sulfate equivalent) with moderate to severe chronic low back pain taking around-the-clock opioid analgesics. Patients' opioid doses were tapered to ≤30 mg morphine sulfate equivalent before open-label titration with BBUP (range, 150-900 μg every 12 hours). Patients who responded (received adequate analgesia that was generally well tolerated for 14 days) were randomized to receive buprenorphine (n = 254) or placebo (n = 257) buccal film. The primary efficacy variable was the change from baseline to week 12 of double-blind treatment in mean average daily pain-intensity scores using a rating scale of 0 (no pain) to 10 (worst pain imaginable). In the intent-to-treat population, mean pain scores were 6.7 after opioid taper and declined to 2.8 after the BBUP titration period. After randomization, mean pain scores were lower in the BBUP group than in the placebo group; the difference between groups in the mean change from baseline to week 12 was -0.98 (95% CI, -1.32 to -0.64; P < 0.001). A significantly larger percentage of patients receiving BBUP than placebo had pain reductions ≥30% and ≥50% (P < 0.001 for both). In the double-blind portion of the study, the only adverse event reported more frequently with BBUP than placebo and in ≥5% of patients was vomiting (5.5% vs 2.3%). These findings demonstrate the efficacy and tolerability of BBUP in opioid-experienced patients taking around-the-clock opioid treatment for chronic low back pain.

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