A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine
In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and en...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-02-01
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| Series: | Journal of Patient Experience |
| Online Access: | https://doi.org/10.1177/23743735221079141 |
| _version_ | 1818940259021357056 |
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| author | Naomi T Katz Martyn Lloyd-Jones Lucy Demediuk Kerry McLaughlin Megan McKechnie Michelle Gold |
| author_facet | Naomi T Katz Martyn Lloyd-Jones Lucy Demediuk Kerry McLaughlin Megan McKechnie Michelle Gold |
| author_sort | Naomi T Katz |
| collection | DOAJ |
| description | In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines. |
| first_indexed | 2024-12-20T06:36:48Z |
| format | Article |
| id | doaj.art-2d8d757bc8244f27aa6a1292128d9352 |
| institution | Directory Open Access Journal |
| issn | 2374-3743 |
| language | English |
| last_indexed | 2024-12-20T06:36:48Z |
| publishDate | 2022-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Patient Experience |
| spelling | doaj.art-2d8d757bc8244f27aa6a1292128d93522022-12-21T19:49:58ZengSAGE PublishingJournal of Patient Experience2374-37432022-02-01910.1177/23743735221079141A Case Study of Pain Management at End-of-Life for a Patient on High-Dose BuprenorphineNaomi T Katz0Martyn Lloyd-Jones1Lucy Demediuk2Kerry McLaughlin3Megan McKechnie4Michelle Gold5 Melbourne School of Population and Global Health, , Melbourne, VIC, Australia Consultation and Liaison Addictions, Alfred Mental and Addiction Health, , Prahran, VIC, Australia Alfred Health Palliative Care Service, , Prahran, VIC, Australia Acute Pain Service, , Prahran, VIC, Australia Consultation and Liaison Addictions, Alfred Mental and Addiction Health, , Prahran, VIC, Australia Faculty of Medicine, Nursing and Health Sciences, , Melbourne, VIC, AustraliaIn Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.https://doi.org/10.1177/23743735221079141 |
| spellingShingle | Naomi T Katz Martyn Lloyd-Jones Lucy Demediuk Kerry McLaughlin Megan McKechnie Michelle Gold A Case Study of Pain Management at End-of-Life for a Patient on High-Dose Buprenorphine Journal of Patient Experience |
| title | A Case Study of Pain Management
at End-of-Life for a Patient on
High-Dose Buprenorphine |
| title_full | A Case Study of Pain Management
at End-of-Life for a Patient on
High-Dose Buprenorphine |
| title_fullStr | A Case Study of Pain Management
at End-of-Life for a Patient on
High-Dose Buprenorphine |
| title_full_unstemmed | A Case Study of Pain Management
at End-of-Life for a Patient on
High-Dose Buprenorphine |
| title_short | A Case Study of Pain Management
at End-of-Life for a Patient on
High-Dose Buprenorphine |
| title_sort | case study of pain management at end of life for a patient on high dose buprenorphine |
| url | https://doi.org/10.1177/23743735221079141 |
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