The Authors’ Own Words:  

We ask authors to describe their impressions regarding the implications of their accepted work, how their findings will change practice, and what is noteworthy about the work. 

The Problem of Pain: Additive Analgesic Effect of Tramadol and Buprenorphine in a Patient with Opioid Use Disorder

Cristina Montalvo, MD, MBS; Nicolas Genovese, BA; & John Renner, MD

Substance Abuse Vol. 40, Iss. 2, 2019

“The treatment of severe pain in patients on long term buprenorphine therapy for opioid dependence remains an ongoing challenge for clinicians across the country. When non-pharmacological and non-opioid treatments prove ineffective, additional opioid medication is often the last remaining option for these patients. However, due to the traditional understanding of buprenorphine’s pharmacokinetics and its strong affinity for analgesic opioid receptors, the efficacy of any additional opioid medication chosen by clinicians would expectedly be reduced. Coupled with the dearth of academic literature examining appropriate adjuvant medication for those on buprenorphine treatment, this decision facing many clinicians begins to seem insurmountable. In this manuscript, we show that our patient had a significant decrease in his pain and an improvement in his daily functioning with the addition of tramadol to his medication regiment while maintained on his opioid agonist therapy, and it highlights a novel and effective treatment option available to clinicians in the management of pain for those on buprenorphine therapy.  Further, our manuscript creates a paradigm for future studies to compare tramadol’s efficacy in pain management compared to other opioid and non-opioid analgesics for those on long-term buprenorphine therapy.“

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