A case series of patients with head and neck cancer undergoing curative-intent chemoradiation receiving low dose transdermal buprenorphine for pain

Buprenorphine is a semisynthetic partial µ-opioid receptor agonist used for opioid use disorder and increasingly for cancer-related pain. Transdermal buprenorphine (TDB) is effective for both nociceptive and neuropathic pain and may be particularly advantageous in patients with head and neck cancer (HNC) due to its pharmacologic profile and non-oral route of administration. Existing literature evaluates the efficacy of high dose TDB (>30 µg/h) in symptom management and demonstrates equivocal effectiveness to morphine. In the United States, TDB patches are only available in 5, 7.5, 10, 15, and 20 µg/h patches with a max dose of 30 µg/h approved by the Food and Drug Administration. Data on low-dose TDB for HNC-related pain and treatment-associated toxicities, including mucositis, are limited.